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grr PERMIT APPLICATIPN <br /> BUILT ; / MECHANICAL / PLUMBING / S; /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: 24(j1 5IQ�h $t -:=>V(\I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> c CCONTACT INFORMATION <br /> OWNER NAME: �' i.i4 -% CL-4(7--vs—)t is TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 24&'1 51(12' Si S\",..1 <br /> 1 CITY G'U/� l\ STATE V V('l ZIP ) IC? <br /> OWNER PHONE: L*2 • �L\7. r'2 Cr) OWNER EMAIL: <br /> L. <br /> CONTRACTOR NAME: 1Jp C..V) L4Uk 4 k k+u LQ �,pm -.k &6 I.tc 1 oy <br /> CONTRACTOR ADDRESS: STREET F D ��" 1 (� 1�l& n <br /> CITY -i (2'v S�1I.� STATE ��/C,. ZIP qts G 0 <br /> CONTRACTOR PHONE: ?j(,�L • I.P E.•9�Ob CONTRACTOR EMAIL: )A� �f c'V�-A- t�Y�\ �� . C P'Y� <br /> � �q <br /> CONTRACTOR LICENSE#(REQUIRED): fh C 6:71-ke.0 �� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): )S tJ'�i� <br /> PRIMARY CONTACT: 0 OWNER [.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: aj(.Q 0 •Lo S6 •9 500 <br /> SibtAr\A__ bp-i.Avek_itAr) CONTACT EMAIL: 'In-Fp CZ f'& y in h.Q eh yn , (_y�Yy� <br /> BUILDING INFORMATION J <br /> F�- /�' <br /> Existing Use of Building: Contract Price of Work: $ J~ vU,Gi <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE: PSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: New ®Addition ❑Remodel ❑Repair ❑T.I. ❑Sign IL Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: . r\ <br /> NOLL'A-vS CCA 2,_ i <br /> acs 'h Yk- j_) k ski if <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 /> 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 Ventilatior 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 /> an. omply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /A„ 2,Qt PERMIZ##0 03J (L��V/�, `oI YIV\I v <br /> Owner/ ttthor(zed Agent Signature Date (Revised 10/10/2018) <br /> yl <br />