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i <br /> BUILDIN��INECHANICALE PLUMBINGCSIGN�/SIPRINKLER/ 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 Piease� PR4�EGT�SITE�AtFQRM/�TION'� ' " ` ��`�� "� <br /> � �.s>.: _�,�:'� �� ��� <br /> PROJECT SITE ADDRESS: '-� ,� Q�� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ° CONTACT tNFORMATION' ` � ' ��'�� �"� `�`� <br /> ; • ,, �._ . <br /> _ . , _ . _ _,N. <br /> � : , �_ <br /> OWNER NAME: A.j(L.L��r �,q�j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srRee-r �' � <br /> C�TY � �� STATE ZIP <br /> OWNER PHONE: _ OWNER EMAIL: (.A�.{ '�[- , , r /}'j�Z/�� 0 <br /> _ _, .. <br /> CONTRACTORNAME: � Ol�.�,`j� ��(��� , . <br /> CONTRACTOR ADDRESS: srReeT 'ZZ %L /,Z��j� <br /> CITY �� (�j.,�� STATE �.r� ZIP <br /> CONTRACTOR PHONE: � '�.l2. CONTRACTOR EMAIL: ((�� �p n /' � .� � �n„� <br /> CONTRACTOR LICENSE#(REQUIRED): ���/V �L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (7 �{2,2,� <br /> ._ . . �,.., . _ . . . , <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,���_3�Z.,-3 �j <br /> �L1�-i�-�1-�1 �j A.'�lZA�L�- CONTACT EMAIL: "�-fL��N°�^'1� i.'�A'M�1 C� �i�L� •c0 <br /> : i �� ��..� -r�'��.`���,���»��d���XIfF����������Y� �#.3����f'��k t��%��°�Xi'���:,f�s�,:'rL7; ?it ���?E�Y,� ,,,,r 6,�5��".��k,:-.2,a�,��s <br /> Existin Use of Buildin : .� Contract Price of Work:$ " i� <br /> Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T pe of Pro'ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECMANICAL PERMIT qPPl.1C!#�T1QI�f_� . ' ' 3:; Pl.11M�1NG';PEI�1�' ..A�P���� Y`"'�� ,,,�;���;,��'�_`Q°� <br /> Type of Project: _New _ Addn �Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixfures #of List of Fixtures #of List of Fixtures #of List of Fixfures <br /> Fi�ctures Fixtures Fixtures Fixfures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavato (Wash Basin) Drinkin Fountain <br /> Water Heater Refri eration 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 /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other: <br /> SPRINKLER/SliRPRESSIQ�1��`I���M�. „ <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permif 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 unde c� mstance.I am the owner,or I am authorized by the owner of this property to pe�form the work for which application is made, <br /> and I comply with the State Contractors L 18.27 RC�and 296.200A WAC. <br /> � City of Everett Official Use Only <br /> �"".__..."",- 4 P T#��^ + � <br /> � L <br /> Owiier/Authorized Agent Signature Date (Revised 9/23/2016) <br />