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PERMIT APPLICATION <br /> BUtLDIN(#IVIECHANICAL/ PLUMBING /SIGN I�NKLER/ 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� PROJEGT SITE INFOItMAT10N <br /> PROJECT SITE ADDRESS: � �}� �'c L'c. ��� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: tii 1 �j �'t,�'2a� � ��C�tY� TENANT NAME(If Commercial): a� '� ! r �' <br /> OWNER MAILING ADDRESS: sTReer � S�Y S� „Ll�(�: U"`C� ��t <br /> CITY ��W�/�,( STATE �� ZIP g��� <br /> OWNER PHONE: �a�" t-(?'4 � ip ' OWNER EMAIL: ►� � '{ , (� G j c�J(�+� <br /> CONTRACTOR NAME; ��C.(�j Vl � <br /> CONTRACTOR ADDRESS: sTReeT a �j � W. <br /> CITY �. �I/��(',�.,�(50(�Q STATE � , ZIP <br /> CONTRACTOR PHONE: ��`�� ' �, — ��� CONTRACTOR EMAIL:���� �' S � " (_p <br /> CONTRACTOR LICENSE#(REQUIRED):�I� �I r�E �� CITY OF EVERETf BUSINESS LICENSE# EQUIRED}:v�lp�� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) <br /> CONTACT�NrAM� �� CONTACT PHONE:������� r ����j � <br /> CONTACT EMAIL: � <br /> BUILDING PERMIT APPLIGATION <br /> Existing Use of Buildin : Contract Price of Work:$ !� <br /> Proposed Use of Building: � � Y� 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. ign ❑Sprinkler ❑Demolition ❑Change of Use. <br /> DESCRIPTION OF WORK: ��� ��� ! (��(.�,,,.� �� � �„��Q �n„� <br /> v�4a ��..r> .,�„�, <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixiures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixfures Fixtures Fi�ctures <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 /> ACKNOWLED�EMENT.•I have�eviewed 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 only authorizes approved work and no deviations therefrom.Deviations musf 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 the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Con cfors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# <br /> N a`.� � .� I��n`f-00 <br /> Owner/Au orized Age ign u Date (Revised 9/23/2016) <br />