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PERIVIIT APPLICATIC�t <br /> BUILDI.__ . i1nECH�4NIC,4L/ PLUIVi�I�IG /SIG� 'RINKL�R/ DEfViiOLITION <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�lack Inlz�nly Please) PROJEC'�'SITE INFORMATIOR9 <br /> PROJECT SITE ADDRESS: �� � j��„t�dL�- (j Y11r�{�� i,t.��-' {- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of lo�g legal description) <br /> CON'TACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): •,` �`; ,-� _, <br /> OWNER MAILING ADDRESS: srReer ], s�.v � _,2�'7'T �� i,l: ��L •7 = � <br /> CITY �J����"^� STATE �„�; � ZIP G� C./, �(,_�•� <br /> OWNER PHONE:L �� -- - � — Z3 Z .7 OWNER EMAIL: <br /> CONTRAI:TOR NAME; , _ �` S�G,.`. `C 2 'c- 7�. L--� �l� <- . <br /> CONTRACTOR ADDRESS: sTReEr ��j']C "— �� �'✓►,``,ti �Z�i /� � � �] Z <br /> CI'fY �_�����V��_i STATE `„/.� ZIP � � G L-�- <br /> CONTRACTOR PHONE: �E, - �f`%� � j j!�� CONTRACTOR EMAIL' - � � Ir c. s it• � � ,-� �.,r- �+-/�t3�,'l � -L�.- <br /> CONTRACTOR LICENSE#(REQUIRED): (7 � " �,�C K- CITY OF EVERETT BUSINESS LICENSE#(REQUI D): <br /> / <br /> PRIMARY CONTACT: ❑ OWNER ��ONTRACTOR ❑OTHER(Please Specify) <br /> CONTAC7 NAME: CONTACT PHONE: 7�E.,.. ��! `'- -3�� � �� <br /> �L:,I�' 1�Z t�� �-r"i CONTACT EMAIL: �c-i ^�L t G' !� " ^cs C t"Z_'.�-� C=', 5^ r `,."' a,,, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: �l�li�% / <br /> Proposed Use of Building: 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. ❑5ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIP'fION OF WORK: <br /> I N 5 �!-1�..� �;,,� �_�t_,4y 1'v�o�;!i i��� ��.'� C F L�Z T�,�2i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MIECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Prc�ject: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisf of Fi�ctures #�f Lisf of Fi�ctures #of List of Fixfures #of List of Fixfures <br /> Fixfures Fixtures Fixtures Fixfures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> 1=orced Air Systems Unit Heater Bathtub Urinal <br /> c;as Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 1Nater Heater Refirigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> c3as Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> F2ange Hood Water Heater Other: <br /> f_xhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the informafion contained herein rs true and correct. Work done pursuant to this permit must comply with <br /> current feder<3l,stafe,and local law. The granting of a permif only aufhonzes approved work and no deviations therefrom.Deviations must first be authorized rn writing from the <br /> Building Official b being authorized under any circumstance.I am the owner,or I am authorized by the owner of this properfy to perform the work for which application is made, <br /> and I com wi the S�te Contracfors Law 98.27 RCW and 296.200A WAC. <br /> � � City of Evereft Official Use Only <br /> � �� R���0 �� <br /> , <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> �, �7 <br />