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PERMIT APPLICATIOI� <br /> BUILD11��111ECHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES' <br /> 3200 CEDAR STREET,EVERETT,VVA�01 <br /> (P)425-257-8810 �.FAX 425-257-8857 �(E)everetteps@everettw�gbv� www.everettwa.gov/permifs <br /> . : • <br /> �. ;.... �:; . ' ; �,. ° _.PROJECT,SITE IN�ORMA'TION,.. : <br /> _. . _ ,. . ... .. <br /> PROJECT SITE ADDRESS:(�/1 r►,-.,d,�}� � PROPERTY TAX G�j (�j 70(�����i a c� <br /> �J��`lJ� �� <br /> LEGAL for new construction: Short Plat/subdivision � � Lot No.� (attach copy of long legal description) <br /> ; ,;' ; :::GONTA4rT 1.N,FO�tM/�T10N <br /> . , .. a� . �. t . ' <br /> , _.. .... <br /> OWNER NAME: �'75��'— K- � TENANT NAME If Commercial : <br /> OWNER MAfLING ADDRESS: STREET �C/� ��� ��v''� <br /> CITY <br /> � STATE ��- Z�P % �/`�� <br /> OWNER PHONE: �C� � � �(� OWNER EMAIL:'` C�C.�( � �`'�-�-� <br /> ....,.,.A. . . .... ,.� _.. ...... ., � . . . v _ M <br /> CONTRACTOR NAME: ' GL��S ��� <br /> CON7RACTOR ADDRESS: STREET d�ax �(�J <br /> C�1y (/r// STATE �� ZIP / �"�V <br /> CQNTRACTOR PHONE: Z��(� 7 7 QF� CONTRACTOR EMAIL: wQ�� C� �'`t-�� <br /> CQNTRACTOR LICENSE#(REQUIRED): (�lC � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �- <br /> PRIMARY CONTACT: ❑OWNER � CONTRACTOR ❑OTHER(Please Specify) <br /> CON�CT NAME: CONTACT PHONE: L�Z����"7 d�j <br /> �LQ�Vv� CONTACT EMAIL: �S � �9G�— <br /> . . .. <br /> ...:� .. <br /> ' ` : : = BUILDING�PERMI7 APPLICATION. ;i; <br /> ,.. :_:_. : -_. ,:. . . .. <br /> Existing Use of Building: (�� � '�jl Contract Price of Work:$ b d � <br /> Proposed Use of Building:�� � r Heat Source: ❑Gas ClElectric ❑Other <br /> Building Type: C7SFR-Detached ❑SFR-Attached [7Duplex I�Multi-Family-#of Units: .ClCommercial C7lndustrial <br /> T pe of Project: C1New C1Addition .�#Z�model �7Repair e1T.l. I�Si n OSprinkler ClDemolitio� OChange of Use <br /> DESC121PT�.QN��K. �AA � D � � <br /> A��� � ��`'`�a ro�� <br /> ASSOCIATED BUILDING PERMIT#(if appiicable): <br /> ... .: ..... <br /> ' MECHANIGAL P�RNIIT APPLIGATfON:� ;: : ;'. : PGl71ilIBINa PERMIT�:APP1fCAT10N. <br /> 7ype of Project: _New Addn Alteration _Repair Type of Project: _New _Addn �Alteration _Repair <br /> #of usf of Fixfures #of List of Fixfures #of Lisf of Fixtures #of List of Fixtures <br /> Fixtares Fixtures Fi�ures 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 7rap <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/BadMopietcJ Other: <br /> .. . . .. • <br /> , .:SPRINKLER I,SUPPRESSION SYSTEM; <br /> Number of Heads <br /> ACKNOWLEDGEMEIJT.•I have reviewed this appiication and confirm the information contained he�ein is true and correct.Work done pursuant to fhis permit must comply with <br /> current federal,sfate,and loca/law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by fhe owner of this property to pertorm the work for which application is made, <br /> • and I comply with the Stafe Confractors Law 98.27 RCW and 296.200A WAC. <br /> City of Evereft Official Use Only <br /> �����/� PERMIT# �1 � r �(� OL� <br /> l� (B l, <br /> O ner/ orized Agent Signature Date (Revised 10/12/2015) <br /> ���. <br /> I <br />