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ATGIONI N
<br /> BUILDING/MECHANICAPLEIRPMLUITAPPLICATION
<br /> GI SISPRINKLER I DEMOLITION
<br /> ,.. .
<br /> 0011111110''
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov i mvweverettwa.gov/permits
<br /> (Blue or Black,InIcOnly Please) -‘ 'PRILIECr SITEINFORMATION
<br /> PROJECT SITE ADDRESS: 2'6'Z..,3 Rt.-ie.,keit:47- A 0 4--- (7120 i PROPERTY TAX#40e.,..6-6.-24,‘/40 F zo 0
<br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description)
<br /> CONTACT INFORMATION
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<br /> OWNER NAME: .::,,,s ),,,. g.A.):50,,,..-, TENANT NAME(if Commercial):
<br /> ...
<br /> OWNER MAILING ADDRESS: STREET ii,:„:77?2,...'.5m 14/ „e::.„A,,,,s, --Ta‘i Oa_ Ade-
<br /> crry e:;xy rzic,T/OA.) STATE 42}/c Z I
<br /> OWNER PHONE: -2 O/ 3;2,-7 •-- a:-.-e73 OWNER EMAIL: Of.,e,0 1.6 e..4so,-,,.../..`e-eiy;r:,Ai.0 o, (:2,
<br /> „ .
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> ,..'” ,,
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR .„,g1 OTHER(Please Specify) rneil •„41f.:.... L '- 7fl i ?".17 t/Szeitiliti.e:12
<br /> CONTACT NAME: CONTACT PHONE: ifo ,..,°- r77- a
<br /> /"7/1Z 4-1;0A-)r,771 CONTACT EMAIL:""tet.:„Atc.)..,)Z.:771 & 7 ,,,,,„, ,/,4.-7,an,
<br /> . . . .
<br /> BUILO:INGPERMIT,APPLICATICIN .
<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: Deas DEleetric DOther
<br /> Building Type: DSFR-Detached DSFR-Attached DDuplex 0Multi-Family-#of Units: 1:3Commercial Dindustrial
<br /> Type of Project: DNew DAddition DRemodel DRepair DTI. 0Sign 0Sprinkler 433Demolition 0Chave of Use
<br /> DESCRIPTION OF WORIS: , ,- -- s tz:egt,- pi 0 ziz A,„,"b.,,,,,,5*,„, A
<br /> 0 Ari 7 , plao iv.R.7741 „, .44,447, e:...,, IV ce„,,,,,,;it.E.7,,,,,, 410 34,,,i :40
<br /> .,..,, •.„•,-.
<br /> ex-v',
<br /> , K44570
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): //149
<br /> MECHANICAL PERMIT APPLICATION ' PLUMBING' PERMIT APPLICATION
<br /> . , , ...
<br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair
<br /> #of #of
<br /> Ft of #of
<br /> List of Fixtures List of Fixtures List of Rxtures List of Fixtures
<br /> xtures Fixture9 Fixtures# Fixtures
<br /> A/C-Air Handling Units / Heat Pump Toilet Backflow Preventer(Inside Bidg)
<br /> , i• .
<br /> Forced Air Systems ‘, Unit Heater Bathtub Urinal
<br /> Gas Piping / Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater ,
<br /> / Refrigeration Shower Floor Drain
<br /> Gas Fireplace ,,,' .Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range / Ducting Dishwasher Roof Drains
<br /> Clothes Oryarliockups Other: Clothes Washer Medical Gas
<br /> Range Lidod . Water Heater Other:
<br /> Epatist Fan /4 i Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER I PRESSION..SYSTEM
<br /> Chemical or,Water 1 No.of Heads
<br /> ACKNOWLEDGEMEAM I have reviewed 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 must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made.
<br /> and I comply with the State Contractors Law 18. 7 RCW and 296.200A WAC
<br /> City of Everett Official Use Only
<br /> .., , PERMED
<br /> ,,,,Id--/ , 3,7".././78'.
<br /> ,
<br /> Own I./Authorized Agent Signature Fe (Revised 9/23/2018)
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