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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Oniy Please) PROJECT SITE INFORMATION <br /> � PROJECT SITE ADDRESS: �O� � ��,�,,�a 't� �`'�t� d" PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> � OWNER NAME: � TENANT NAME{If Commercial): � 5 �,L <br /> OWNER MAILING ADDRESS: srReer �b Q� 1 � <br /> C�7y STATE � ZIP ��j <br /> 01NNER PHONE: 6 �— �Ii OWNER EMAIL: <br /> � CONTRACTOR NAME: GC D 6 . ` �< � � <br /> CONTRACTOR ADDRESS: sTaeEr -L ,50 <br /> arr sTa� �G.n ziP �'�`��.� <br /> CONTRACTOR PHONE: � CONTRACTOR EMAIL: � ,f�' � � ` Ca�+�. <br /> CONTRACTOR LICENSE#(REQUIRED): �` ,� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�'�J lp � <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONT�.�F,NAME: CONTACT PHONE: � <br /> c' � � �� CONTACT EMAIL:�� O � <br /> BUILDING PERMIT APPLICATION <br /> � <br /> Existing Use of Building: Contract Price of Work:$ °T�0�°'� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION F WORK' p, <br /> ��S���alrar� o�t�elri err��a ��u�pevt��,�lor re-Ma�l o���-��+``�ce55cn, !,�'ec�,. <br /> � J � <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION' PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration Repair Type of Project: _New _Addn Alteration _Repair <br /> #of /rst of Fixtures #of List of Fixfures #�f List of Fi�cfures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER f SUPPRESSION SYSTEM`' <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm fhe information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,stafe,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 O�cial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Only <br /> �----�—` PERMIT�p n I V�� �� <br /> ; C `� �U <br /> OwnedAuthorized Agent Signature Date (Revised 9/23/2016) . <br />