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IIIIIIII 0,46-77- PERMIT APPLICATION in <br /> BUILDING �VIECHANICAL/PLUMBING/SIGN/S�I NKLER/ DEMOLITION <br /> F 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink OnlyPlease) PROJECT SITE INFORMATION , <br /> CPROJECT SITE ADDRESS: 3 cp k ------- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: IJAJsc 0`'e�� �� , ,�� (�TENANT NAME(If <br /> Commercial): <br /> OWNER MAILING ADDRESS: STREET (p ( N %V� C-)1 l <br /> CITY - STATE j ZIP J 52e <br /> OWNER PHONE: OWNER EMAIL: VVV���"' '" <br /> CONTRACTOR NAME: • <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther _ <br /> Building Type: ❑SFR-Detached DSFR-Attached DDuplex DMulti-Family-#of Units: DCommercial Dlndustrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair DT.I. DSign DSprinkler DDmolition DChange of Use <br /> DESCRIPTION OF WORK: rcr v 0,p ei✓W rl 1 Curt pyyyti (,t/Ary, <br /> Y <br /> aMol v -c `vl lot -v cmc CPQ. <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 Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 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 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM`_ <br /> Number 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, .tate,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 Offici./before being authorized un'- any circumstance.lam the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and comp! 'ith the Sjjj-,,,'e Contractors L. :.27 CW nd 296.200A WAC. <br /> City of Everett Official Use Only <br /> .) <br /> / /,,,,••• q (/ PERMIT# 6tIC 002 <br /> 0 nerlAuthorized • ,-. Signa ure Date (Revised 5/20/2016) <br />