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����r� ����.a��a�Y�ic��v <br />- �l.1I�.��/ illd�CC-f�'.V�i�da�. / PLlJilfi�li�� / SI(����9f��CL�� / ��ii1���,.1�y�lU�! <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREl-I�, WA 98201 <br />(P) 425-257-8810 � F/aX 425-257-8857 �(E) evereiteps@evereftvra.gov ��rn,v�a.everett��a.gov/permifs <br />,.. . . . <br />... > ....-: <br />_... . . . .: . . ... . .. ... ........ . . <br />:,BUILDING. PERMIT.,A�PLI.CATIOIV <br />-:..... . L , <br />Existing Use of Building: Confract Price of Work: $ '%, <br />� <br />Proposed Use of Building: Heat Source: ❑Gas Elecfric ❑Other <br />Bui(ding Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Mulfi-Family-# of Units: ❑Commercial ❑lndusfrial <br />Type of Project: ❑New ❑/�ddition ❑Remodel ❑Repair .I. ❑Sign ❑Sprin!<ler ❑Demolition ❑Change ofi Use <br />DESCRIPTION OF WORK: ' <br />.� t:��;,v=� ��c..�' -{ (�'� ��—�L-�i-� � � ��',�1 �Y 5�-(,E'�,,,�L <br />ASSOCIATE� BUILDING PERM[T'# (if applicable): <br />� . ........:... ,. . .. <br />.. <br />�6�1PIf1(�Ilt�l� P�Ri�9'Y'.:�PPLI�ATI�IV' <br />Type of Projecf; ^New _Addn _Alterafion _Repair <br />Fixfures �-�st of Fixtures FI # �� S List of Fixtures <br />Toifet Backflow Preventer Qnside Bldg) <br />Bafhfub Urinal <br />Lavaiory (Wash Basin) Drinking Founfain <br />ShoSver Floor Drain <br />Kifchen Sink & Disposal Grease Trap <br />Dishavasher Rooi Drains <br />Clofhes Washer Medical Gas <br />VUaier Heafer Other: <br />Sink (Seivice/Bar/Mop/efc.) Other: <br />ACKNOWLEDGEME.NT,• 1 have reviewed this application and conti�m fhe informafion confained herein is true and correr,t. Wo�/t done pursuanf to fhis permit must comply witl� <br />currenf federal, state, and local law. The granting of a permit only aufhorizes approved work a�d no deviations therefrom, Deviafions musi first be authorized in writing f�om the <br />Building Official before being authorired u any circumsfance. I am the owner, orl am authorized 6y ihe owner of tliis property to perform the work;or which application is made, <br />and l comply ifh th State Confracto _aw�8.27 RCW and 236.7_OOA WAC. <br />City of Everetf Offcial Use Only <br />PERMIT <br />�� l��? /l� 1�1 � � � <br />Owner/Authorized Ayent SiJnafure Dafe (Revised 5/20/2096) <br />