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MI PERMIT APPLICATION <br /> �'�( BUI DING —CHANICAL I PLUMBING/SIGN / II WINKLER to = • 'ry <br /> ECITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or.Black Ink,Only,Please) . N. ;PROJECT:SFEE ifOOKMOISIENNEINERIMEREEENMENEM <br /> PROJECT SITE ADDRESS: 110 5 ()MIA ` , • PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT NFORMA'TIOt+1 . . . . , . . . . . <br /> OWNER NAME: & \,,,QA Ar,f s‘,Q \i‘(1' j Or L L CTENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET/ H-22 44 1(1,4...e k \,,) ate( ,/1 <br /> CITY L rr l<Q f Q 1 O. - PAP IT I STATE` \,J2 Q <br /> A- ZIP (1%1S- <br /> OWNER PHONE: 0 Co- c\\`1. 2-G 1 6 OWNER EMAIL: Q! 1-7.i dav'A ggo3'1(2 o2:1ou- c c,e'l'1 <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 /> PRIMARY CONTACT: KOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> EUILdNC,INFORMATlN <br /> UseiWiZi <br /> ._ <br /> a� <br /> Existing of Building: Contract Price of Work:$ G CI) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Y V I btk tt r✓� �t. -ei' 1 k €fin O(al.vr <br /> 06 VI -0113 - AU e ck 41, .6ad \Kw.. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT,APPLICATION„ ,. ,PLU,M1IBING PERMIT AA,PUC 1 ION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER!SUPPRESSION StS`t"EIVI Sewage Ejector or Sump Pump Other <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads. <br /> ACKNOWLEDGEMENT-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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett I,T�# Official <br /> Use Only <br /> G- i r PERMf , j I N <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) p/1 <br />