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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Mig 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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) PROJECT SITE INFORMATION <br /> ry <br /> PROJECT SITE ADDRESS: 62/-ii, o PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: h / /3 DSS TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ,r ALJ ,/ (7_,:vic:14.-2_,v �^f- ���^^^ <br /> COY STATE�7, ZIP r �L y . <br /> OWNER PHONE: b- 7/ 3 17 3 t'} OWNER EMAIL: <br /> CONTRACTOR NAME: 0101N2.1./ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQU ): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> Ce-Ge w 2'5. . 2. BUILDING INFORMATION <br /> Existing Use of Building: 5/0 t,r r 3 ,i9 < e Contract Price of Work:$ .C/ <br /> Proposed Use of Building: .. J 1%—s— Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. 0,0,Si n ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �� (5, / <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 c. + w' the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Ir MO' PERMIT#. City ofEverett Official Use Only <br /> / / D1-1 -'00 <br /> ' } 00 <br /> Owner/Authore d Agent Sig ture Date (Revised 10/10/2018) <br />