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I 'MECHANICAL <br /> APPLICATION <br /> BUILDING?MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: DODO 7 4,JC,/► 57 PROPERTY TAX#: Z 9O 5 / 7 DOL e./Sd G <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: eve„c# Ca Os..„"„„4;t, Cd/v,, C TENANT NAME(If Commercial): 5 v„,.,,„ <br /> OWNER MAILING ADDRESS: STREET ,tZ pG /-0.d.,..00-? t✓c - S-f- <br /> CIQ <br /> TY eve,AcH-L STATE 4.404ZIP 91/e:Ye/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: gt.b,,,,, 6 <br /> CONTRACTOR ADDRESS: STREET 953/ ,V /y",024- 1t- • <br /> /�/`�� <br /> CITY I�1.^1k/ii {,) / STATE 4.)A ZIP ` 11 3 <br /> CONTRACTOR PHONE: z/L� 6j 9/ 9,983 CONTRACTO- MAIL: y A.50.` iX,,enO b SO! L�O. C°St- <br /> CONTRACTOR LICENSE#(REQUIRED): /QA4 SO it 0 0 5 5 G)Q ..CITY OF EVERETT BUSINESS LICENSE#(REQUI•'D): /Z Sur <br /> PRIMARY CONTACT: 0 OWNER grCONTRACTOR ❑OTHER(P 4'se Specify) <br /> CONTACT NAME: � j� ;' CO ACT PHONE: �Z�„.,5 9/ �B <br /> �e"5` t t,)6J_' i NTACT EMAIL: <br /> � ` l�tSv>K. Q � �v�3aK .Gc►�c1 <br /> 1 <br /> BU L -,r PERMIT APPLICATION <br /> Existing Use of Building: , \ Contract Price of Work:$ 5 'OD <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ,'Commerc' I El Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler emolition ange of Use <br /> DESCRIPTION OF WORK: _crJ d �Jc <br /> 67hiut)vrI . 7444'c N7-7 <br /> 0 e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn 74Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 3y Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub /s Urinal <br /> Gas Piping Boiler /Z. Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan q Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> .---__ V 9/z4B "lilt <br /> ES tSoa . c02_ <br /> Owner/Authorized Agent ignature Date (Revised 9/23/2016) <br />