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PERMIT APPLICA71(:: . <br /> �UILD___ _ / MECHANICAL/ PLUMBING / SIGIV 1 �PRINKLER 1 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 Only Please) PROJECT SITE INFOIZMATIORI <br /> � PROJECT SITE ADDRESS: 7 J�- ,�j,s�- �7 ,�J' J T ; �f� � Z,> PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> _ OWNER NAME: � / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREer �� • L `) ,/.� L�, , �_ <br /> CITY � �� ' STATE �'/� ZIP �/� �J/� <br /> OWNER PHONE: L y L�j .. SJ )� ��� U ` OWNER EMAIL: �,� � i <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: sTReer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ��- �� � � <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 ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �P � <br /> ��H � U�'� �;u (Uo� !' �rV �-� �' r';� `rv ruJ � <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 Lisf of Fixtures #of List of Fixtures #°f List of Fixtures #°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/SUPPRESSION SYSTEM <br /> Chemical or Water No. 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 on/y authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Otficial before berng authorized under any circumstance.I am fhe owner, or I am authorized by the owner of this property to perform the work for v✓hrch application is made, <br /> and I comply with the State Confractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � � � PERMIT# ' �� ;� � <br /> i ;, J , .L� � , <br /> r-.� �— i <br /> � ,;� <br /> ner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> ,�� � <br />