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PERMIT APPLICATIC ..
<br /> BUILD�J MECHANICAL/ PLUMBING /SIG� UPRINKLER/ 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 Irik On1y;.Please) �PROJECT SITE INFORIVIATION �?
<br /> PROJECT SITE ADDRESS: 1 `�� �i��--�Y /�Tv� PROPERTY TAX#:��P��Z�Li(�pt>Zc'�PjjO
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
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<br /> ' ", : �` CONTACT I,NFORMATION i ,
<br /> OWNER NAME: � ��,��+�uf TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: s-rReer 3���,Q l. S�/
<br /> CITY STATE �ZIP ���O
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME; FI l�i�..
<br /> CONTRACTOR ADDRESS: s-rRee-r
<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: '`�j`�-� �(],(�
<br /> �'"�� ��f��� v/ t�� CONTACT EMAIL:
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<br /> ` BUILDING;PERNIIT`APPLICATION.:: � ` � tt
<br /> Existing Use of Building: ,�j ( a�� 1�XL- Contract Price of Work:$ �
<br /> Proposed Use of Buil ' g: ��'n�1i� 1 /��1.- -- � Heat Source: ❑Gas Electric ❑Other
<br /> Building T pe: 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: x„ ,' ��I , I ` �.., ����r � �� �
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<br /> .��fi��-�c�� � � r����i a � � (�� ����� ��
<br /> ASSOCIATED BUILDING PERMIT#{if applicable:
<br /> ' : MECHANICAL PERMIT APPLICATION'_ PLUMBING PERMIT APPLICATION. '
<br /> Type of Project: _New_ Addn _Aiteration _Repair Type of Project: _New _Addn Alteration _Repair
<br /> #of List of Fixfures #�f List of Fixtures �°f List of Fixtures #of List of Fi�cfures
<br /> Frxtures Fixtures Fixfures Fixfures
<br /> A/C—Air Handling Units Heat Pump � Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater j Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> � Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove F Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Other:
<br /> Z Exhaust Fan ( Sink(ServicelBar/Mop/etc.) Other:
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<br /> SPRINKLER/�SUPPRESSION=SYSTEM ° ,..� _
<br /> Number of Heads�
<br /> ACKNOWLEDGEMENT.�l have reviewed this application and confirm the informafion 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 fherefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this properly to perform the work for which application is made, '
<br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Eve�ett Official Use Only
<br /> 2 PERMIT
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<br /> Owner/A rized Agent Signature Date (Revised 5/20/2016) �
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