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PERMIT'APPLICATI <br /> BUILD� MECHANICAL/ PLUMBING /SIG _�'RINKLER/ DEMOLI7'lON <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) PROJEGT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �� � � PROPERTY TAX#: <br /> LEGAL for new consfruction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> � CONTACT INFORMATION <br /> OWNER NAME: Gl"t' � � -� TENANT NAME(If Commerciai): <br /> OWNER MAILING ADDRESS: sTaeeT 3 C S <br /> CIN L STATE ZIP <br /> OWNERPHONE: �j • .P'"-,� . OWNEREMAIL: GIa�.Y"�G`� CV��� W�• OV <br /> CONTRACTOR NAME; (�� �,,, <br /> CONTRACTOR ADDRESS: srReEr ' <br /> crrv "' � STATE ZIP <br /> CONTRACTOR PHONE: t"'j . 8-_ g CONTRACTOR EMAIL: <br /> CONTRACTOR LIGENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> ...<. . . . . . . . <br /> PRIMARY CONTACT: �.OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: C�.�c-.J. ���� CONTACT PHONE; /� , <br /> CONTACT EMAIL: �• wa . D <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: �+ r� Heat Source: �dGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Atfached ❑Duplex ❑Multi-Family�#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New �Addition ❑Remodel '�IRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> -t�� � �'�tcou � �x�stt� �= � ��� wl-r� N�w � <br /> ASSOCIATED BUILDING PERMIT#(if appiicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: ,_New _Addn _Alteration _Repair <br /> #of tist of Fixtures #�f Lisf of Fixtures #of Lisf of Fixfures #of Lisf of Fixtures <br /> Fixtures Fixtures Fixtures Fixfures <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(Vifash 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 Ofher: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:l have reviewed fhis application and confirm the information confained herein is true and correct.Work done pursuanf to this permit must comply with <br /> current federal,state,and local law.The granting of a permif only authorizes approved work and no deviations therefrom.Deviations must firsf be authorized in writing from the <br /> Building Otficial before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of fhis property to perform fhe work for which application is made, <br /> and I comply with fhe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Everetf Official Use Only <br /> � ! PERMIT,�#(��;� — Q�� <br /> l� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 4 I� <br />