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PERMIT APPLICATION <br /> PUILDIP MECHANICAL / PLUMBING / SIGPRINKLER/ DEMOLITION <br /> • '' 143 CITY OF EVERETT PERMIT SERV6LU <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFO'•;MATION <br /> PROJECT SITE ADDRESS: 3 7 13 R U (f y_(t Alit cu.,('-4- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) I <br /> CONTACT INFORMATION <br /> ' OWNER NAME: AR1 et gs‘ t-I c-‘(--- 10 6, <br /> - _ TENANT NAME(If Commercial): 0 F ( /4 /4 r) C 11 ;(6 Ipcot•T <br /> 7 OWNER MAILING ADDRESS: STREET <br /> \ CITY STATE 7IP <br /> OWNER PHONE: L"/26 - 2 5T" -/'3 65 B OWNER EMAIL: <br /> CONTRACTOR NAME; ,() p1 Vv► b i� c ,,g A..0-e (yL. C <br /> CONTRACTOR ADDRESS: STREET 1 Q (1 G.e et,in eiI J! c t) 1 ae, to <br /> CITY t.' at, h t -L STATE to f\-' ZIP EN-0 2 <br /> CONTRACTOR PHONE: tJ q -ro 7e - ,3 z CONTRACTOR EMAIL: 7 VII € 15 c('i0ct:1-I1(,Li'Z, A ', yvi , C O '(•✓/\ <br /> CONTRACTOR LICENSE#(REQUIRED): ' Aib/., e/U.Q 116.5 Qrj CITY OF EVERETT BUSINESS LICENSE#(REQUIRED(2(7/' <br /> -`s' <br /> aenl�� ' CI�ONTRACTOR ❑ OTHER(Please Specify) <br /> PRIMARY CONTACT: �Uvv,.�r� <br /> CONTACT NAME: V 4ONTACT PHONE: J( , C( - c 7C( - L 3 g <br /> /(/IOL, Ct,rl'� 5 -Gis- CONTACT EMAIL:``"-w..._ <br /> •R,. <br /> BUILDING PERMIT APPLICATION <br /> -........p.„L. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached EISFR-Attached ❑Duplex ❑Multi-Family-#of Units: mmercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ORepair DTI. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �) 0 \iv, 'L„ 5 <br /> T. 1 ct U Pvetr y/ R e--)t rl, X316 6 3 -6.S L1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): a(00 -3 ---0 <br /> MECHANICAL PERMIT APPLICATION PLUMBINPERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration _Repair Typeof Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: t.-/ Clothes Washer Medical Gas <br /> Range Hood Y' Water Heater Other: <br /> Exhaust Fan Z Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> (,a <br /> City of Everett Official Use Only <br /> ,////4",‘,"7 " -- 2- Z C - (k, _ <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />