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PERMIT APPLICATRdIV <br /> #147""4. <br /> BUILDING /MECHANICAL/PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> ,411 -1 <br /> 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:bib iS1-1 '-,-,u3 CAsei-c tu3- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: K-t✓Vl/.� -Aczx.-A• TENANT BUSINESS NAME(Commercial):A\p j C`,Qay\i jv <br /> OWNER MAILING ADDRESS: STREET kip/..0 -1SThsk Sui , <br /> CIN \(Q(e-S-A- STATE w PT 1 ZIP <br /> OWNER PHONE: 47e,"-1CQQ 312_\ OWNER EMAIL: ,Levlrl 6 I�-GCZ>�.0CA 1 6ectn1(t <br /> CONTRACTOR NAME 1:::)€•61 1 S ConS-r c W\ <br /> CONTRACTOR ADDRESS: STREET \1S1:1i-'/". S'I— IL Q[� <br /> CITY L.C.4 l6A Sk\I u.lirt 5 STATE ZIP 9 CJZ� <br /> CONTRACTOR PHONE: 42,c-, J.A0.1 ©lt2(g(IS CO CTOR EMAIL: Q%ccA;te4QA'c.6)S—C6Y)S - -cci <br /> CONTRACTOR LICENSE#(REQUI ED):� ( (\ 9,411�-. CITY OF EVERETT BUSINESS LICENSE#(REQUIR : 65ci 3�'-, <br /> PRIMARY CONTACT: 0 OWNER aCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: zsi L6 cjcicl ou(.0(p <br /> C(2_AAC.1 CONTACT EMAIL: L, i c, &Act',\S'6Q( U C m • Cow✓' <br /> BUILDING INFORMATION <br /> Existing Use of Building:Co ecci p., 'c, j(ct Cb. Contract Price of Work:$ .ZO 0 0- -- <br /> Proposed <br /> Proposed Use of Building: Heat Source: ❑Gas tlitt lectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: cidcommercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel El Repair T.I. El Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: t <br /> Cctic�. N('f v,rl t. ( OV•e cAr .sLc�GX Y1._(2:-Lc.V't% i-R__ <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 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 /> Chemical or Water 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 <br /> made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Onlyly� <br /> �_ <br /> / 21 <br /> 6 ` l PER n.O 1' V\J <br /> Owner/AutW ed Agent Signature Date (Revised 10/10/2018) <br />