|
P�RMIT.I�PPI�(Cd4T'f
<br /> `°. � �lJl��1 '/t�i�G�A�1�aAL.1 PLIJEi�I�il��I SI��S��(�1KIL��/ ���i1flOL,IT➢��1
<br /> � GITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETl",WA 982d9
<br /> (P)425-257-8810 ( FA3C!25-257-8857 j(E}euerefteps@everetfwa.gav� �vww.everettwa.govlpermits
<br /> , . .. .,. � ....... ...- . ... . _.. _�....:.. . . . - .
<br /> . .... .:. ..... .........:.....
<br /> : -:
<br /> (�9i��.a��C����P�`ll¢u�ti��v�jj G�ll��i��� :' �. . �4���C��1T'�ll�"� p�,'t1����H�St H��. �..� � ' � �
<br /> P�oJ�cr s�T�Anr�R�ss: �°� > ,. � � ��_�, PRop��z�-Y ra7c�:
<br /> L�GAL for new consfr�ction: Short Plat/subdivision Lot No. (affach cQpy of Iong legal description}
<br /> , .. .. ... _. ....: ; ., .. . , ,. . . .. .. _ .
<br /> ,.. _ ,. ...... ..., .
<br /> .. ...
<br /> :.:,..• . ..,_. ....._... - . , ,
<br /> ,._ ;_...,. . , : :: -� • ..: ...... _;�.. ...��I�Y���`�,�1r,��I��r�1T�Q&� :
<br /> OWNER[VAME- j � , i � 1 TENANT N�ME(If Commerciat}:
<br /> OWPIER MAILING ADDRESS: srR�r ? �'"� �.'~ A'`".� -'`_ =" _ Ll�` 4t' '
<br /> CITY "~��;,,7 Sl'ATE �.�l� ZIP
<br /> ,;T-:7
<br /> QWNER PHO�E: yZS J I�..� OW(�IER ENIAIL.: , � +�
<br /> 6
<br /> ..-....�::�,..,.. ....v........w... ............... .....i.............. r...�.-.. .,.. .....-......._... ...�............ ..... -
<br /> � r
<br /> CONTRACTOR NAME: (�=� �- > � ,'QL
<br /> GO[�iTRACTOR ADDRESS: sTReEr Z.L�p :�C.f�� �Cr
<br /> CI1Y � '� STATE �;a ZIP R��-EJ �
<br /> COIVTRACTOR PHONE: �Lt'`L� Z�'L- 3{(+-{�- CONTRACTOR EMAIL: t^�v'�Q..Q�.f.sV"►�I Cc1�<C'd pt�
<br /> CONTE2ACTOR L10ElVSE#(REQUfRED): �--V�(Z�,v',,,� � CITY OF EVERETT BUSINE9S LfCENSE#(R�QUIRED}; �
<br /> PRIMARY�CONl"ACT: ❑OWNER .�CONTI;ACTOR ❑OTNER(Please Specify}`
<br /> COI`[TAGT MAME: . C(]NTACT PHOME: �.,�� s'�y� ._�j--�� -�
<br /> �L�t� ��j CQN7ACT EMAIL. �i�6��/SS`Y�LC���.•�j'v�
<br /> .,. . .- - _...,.� � - � • • - ' • � ' •
<br /> . . . . . . .
<br /> .. .
<br /> ,. �.�'.° . - � . .:�. . . . :BUILDING.PERN(fT;�PPLIGAT[�N - .
<br /> Existing Use of Building: Confract Price of Work:$ � �
<br /> Proposed Use of Building: Heat Source: as ❑Elecfric ❑Other
<br /> Building Type: FR-Detached ❑SFRAttached ❑Dup(ex ❑Multi-Family-#of Units: ❑Commerciaf ❑Indusfriai
<br /> Type of Project: ❑New ClAddiiion ❑Remodel Repair C1T.1, ❑Sign ❑Sprink(er ❑Demolifion C1Change of Use
<br /> pESCRIPTION OF WORK: ,. �
<br /> �.�i,��.:t.:= L�;(..�-`C �,�,�� �c.�lZr.��tt�.�- �- �-'�"�t�'�"
<br /> ASS�CIA7'ED BUILDfNG PERMlT# if a plicable}:
<br /> ,:_, .:. . ._ . . . . . . .__,.....:........ . ... . ... . . . , • . . .
<br /> . _...... . _. -. . . ......._.-.,. ... .
<br /> . . . .�vr��w��aa��b:�����-������c�,r�o� , - . . � ��a������ �����r;,����r�,��-���
<br /> Type of Projecf: _New _, Addn Alterafton _Rapair Type of Projecf; _,New Actdn Afteration �Repair
<br /> �°f List of Fixiures ��f List of Fixtvres �°� List of Fix#ures #°� List of FixtUres
<br /> Fixfures Fixtures Fixiures Fixfures
<br /> A!C—Air HandJing Units Heat Pump Toilet Backflaw Preventer(]nside Bldg}
<br /> rorced Air Systems Unif Heafer Bathfu� Urinal
<br /> Gas Piping Boiler Lavator,�(Wash Basin) Drinking�ountain
<br /> Wafer Heafsr Refrigeraiion Shower �loor Drain
<br /> Gas Fireplace Wood Sfove Kitchen Sinl<&Disposal Grease Trap
<br /> Gas Range Ducfing Dishwasher Roof Drains
<br /> Cto#hes Dryer Hookups Other. Clothes Washer Medical Gas
<br /> Range Haod Water Heater Ofher:
<br /> Exhausf Fan Sink(Se�vice/Qar/Mop/efc.) Other:
<br /> _.:_�,.... .......� _ . ._ . .-
<br /> _...,..._...� .:...,.-.. ......_.,..._- • -
<br /> �.:�:>: ;����P�9C�(L��,/��P��I���dOEd.���`�'�fl�l.. . ;..-
<br /> I�Iumber of Heads
<br /> ACi�NOW!_EDGEMENT.�1 have revfewed fhis application and confirm the information confained herein rs trve and correct tNork do�e pursuanf to this permit must comply wifh
<br /> currenf federal,sfafe,and local law. The g�anting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be aufhorized rn w�iting from the
<br /> Qui/ding Orfrciaf before being authorized under any circumstance,1 ana the ownar,or!am authorized by fhe owne�of tftis propedy fo perform ihe work for which applicatfon is mad�
<br /> and i comply wifh the Sfate Confractors Law 18.27 RCW and 296.200A WqC.
<br /> --, Crty of EverefP Official Use Only
<br /> ; � f,% PERMIT
<br /> " � �� �c�. r � ZJ d�
<br /> OwnerlAuthorized Agen�Signa ure Dafe (Revised 5/20/2096) .
<br />
|