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PERMIT APPLICATION <br /> ,IP,,,,A ,,,,-ABUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 411 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please),, PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /a6 SE Ev-e.RL-1- MDC II Iii oti C11 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: FLC I i0)1 S COO SStn 6 �e¢S TENANT BUSINESS`�/ NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET /^et,D S6 611LR.4 44(if WO(If C� _ _ <br /> CITY f-��k,ef i STATE VA ZIP q8 p,®8 <br /> OWNER PHONE: `I OWNER EMAIL: <br /> CONTRACTOR NAME: L V h C©v,s hF.u. -ej Oh LL\ <br /> CONTRACTOR ADDRESS: STREET O 3 16 f l j..„ o/n �J <br /> CITY Ev-„,�,E,Ft. STATE 1/174 ZIP 962,2 o g <br /> CONTRACTOR PHONE: 1(5,S—g79 -97&O CONTRACTOR EMAIL: 1 vd Ile 1.0 15 @ g yy)cr f , e :4 1 <br /> CONTRACTOR LICENSE#(REQUIRED): �`` Cvfl C OC L 8l/7t�W <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRI�D)es: J <br /> PRIMARY CONTACT: ❑OWNER XCeNTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAfME: / CONTACT PHONE: 25� 79 -9 7 ® i <br /> 1i /-c l l t Shu K CONTACT EMAIL: L,V(l (ICLOIS' 0 �q ct t. C-DYY\ <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ eL 0 00, 0 O <br /> Proposed Use of Building: Heat Source: ❑Gas JR1Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: J <br /> R.e (ac(h 1c 3hsL .li tx.fi©r\ x DI2tj. WrX/( �s1 cdl(ihtq Pens 6/0(5,- �t t sura <br /> ASSOCIATED BUILDING PERMIT#(if applicable): e1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—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 SYSTEM 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.I am the owner,or lam 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / , 0.2�- LI H 9 PERM gl0� — V(,. <br /> Owner/Authorized Ag n Signature Date (Revised 10/10/2018) <br />