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PERMIT APPLICATION
<br /> BUIl.DING�CHANICAL ( PLUMBlNG / SIGN / �tNKLER/ DEMOLITION
<br /> CITY C3F EVEf�ETT P�Rft1'T S�R�,�fCES
<br /> 3200 GEDd�i-t�TRc=T,�VERcT?",WA 98201
<br /> iP}4Z i-�5'-r�d!�a � Fr�X��25-2;i7-8357 �{E)vveretteDs@evere!itiva gov I �vUuvvevaralf:,va��ov!p�rrnit�
<br /> �Blc�e or Black Ink iD�1y P{����} PROJECT S�TE INFORMATION
<br /> PRQJECT SITE ADDRESS; �(�,t��1��, ��^��� "S � �j� 'PFtOPERTY TAX#: C`� C.%q f� �������C?C�
<br /> ;�.�C"sAl for new�o;�struction: Short�'labsuodn�iai;��, �
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<br /> _ CONTACT INFORMATION
<br /> OWNER NAME: �;e.;� ��? ,�t� � .� ,, �
<br /> _ ���'��°"�-�=---t '€��. TENANT NAME(If Commerci�i).
<br /> OWNER MAILING ADDRESS; ;raE,r � ` 'y��n ��� �'����, �,��
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<br /> _ �r�v ��� � �X��.�.,�'� � �_,L�, � ..
<br /> �1 d i ii �f 1 IIP ��•t�1.�t-�.
<br /> OWNER PHONE: �'IE;��'�",? �2G �P���(� OWNER EMAIL:
<br /> CONTRACTOR NAME; �� E�,�� a � �,�•�
<br /> CONTRACTOR ADDRESS: :.T,zwE�;� �?�'��� �� �? � �
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<br /> CONTRACTOR PHONE: �°`��,`-�� .�'�}C.� p�^r.�"�'"� _t CONTRACTOR EMAIL; � `�`"'_-�#-F�� , � .� ��`
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<br /> CONTRACTOR UCENSE#iRE(�UIRED)r ._�;�(���,,��L.��' y�e��,���` �J"�,d.��'� CiTY OF EVERETF BUSINE55 UCENSE#{REQUIRED):� ���( _�� i�`"
<br /> PRlMARY CONTACT: ❑OWNER �Cc��'��q�T�� ❑OTHER(Please Specify)
<br /> CONTACT NAME: ~ CONTACT PHONE: " y4. s
<br /> ��''���.���:�;�"�" �- - ,��.�-`�-i �,_;-�
<br /> GQt�1TACT EMAI�:y�Y°!.r'.,.�"";.�' �t..t�"t� ���:G Y���:�.<�'f`i,'," [i�M
<br /> BUILDING PERMIT APPLICATI�N
<br /> ixisiu7�Use of Buildrn Contract Price of Work: $ �x��:.� ��
<br /> 't�p�s��Use of Buildin ° Neat Source: �s ❑Eiectric C�Other
<br /> 3.iif�°iir� T pe OSFR-Defached ❑SFR-Ai*.ached ❑Duplex ufti-rarreEly-fF of Uniks: ❑Commercia! ❑Industrial
<br /> -y�e of Pr�j��t: ❑New ❑Addifion ❑Remodel l���air ❑ ,I. QSi n ❑Sprink{er ❑Demolition ❑Chan,�of Use
<br /> )ESCRIPTION p�WORK:
<br /> ��� �C�-- �� � � � �5_ �-�W�
<br /> ��� �
<br /> tSSOCiATED BUILDWG PERMIT#{if a +►icab���:
<br /> MECHANICAL PERMIT APP�.ICATION PLUMBING PERMIT APPLlCATION
<br /> ype of Project: ____New _ Addn �Alteratlon Repair Type of Project: New Addn Alteration
<br /> –` epair
<br /> #of �of #of �
<br /> �ixtures Lfst of Fixtures L(st of Fixtures Llst of Flxtures #�f
<br /> Fixtures Fixfures Fixtures �1st of Fixtures
<br /> A/C–Air Handling Unifs Heat Pump Toilet Backflow Preventer{Insid�B��iy)
<br /> Forced Air Systems Unit Heater Bathtub
<br /> Gas Pi in ������
<br /> P Boiler Lavatory(Wash Basin) E�ri�7kin�Fountain
<br /> Water Heater Refrigeration Shower Floor i�r�in
<br /> Gas Fireplace Wood Stove Ki en 5ink&Dispasal Grease Trap
<br /> Gas Ran e Ducting y ishwasher R��af Ctrains
<br /> Clc�th�s❑ry�r Hc�aku�s Other. Clothes Washer 11�i�di�a1 Gas
<br /> Range Hood Water Heater (����r_
<br /> Exhaust Fan Sink(Service/6arlMopletc.� U#hnr;
<br /> SPR#NK1.ER/SUPPR��i�ItiN SYST�M
<br /> Mumb�r cf Heatis
<br /> :KNOWLEDGEMENT:I have reviewed this applicafion and confirm fhe information contained herein is true and correct. Work done parsuant to this permd must comply wiih
<br /> vrent federal,stale,and local law. The granting of a permil onty auihorizes apprnved work and no deviations therefram.Deviafions must 8rst be autl;orized in writing trcm ihe
<br /> �ilding Offtclaf botoie 6eing authorized under any clrcumsfance.!am the owner or!am authorized by the cwner of}his property}c perfr,rm ihs work inr which app(icaficn is madE.
<br /> id 1 comply with,ihe Siate Ccnlractors Law i8.27 FCW and 296.2GUA WAC.
<br /> Git y cf Everett O�ciaf Use Only
<br /> °Jf�f/r�/ f� [}�-^'''��� (pp9tj, .��_,J''�w (/'�) � PERM/ry'T\//.�}{\
<br /> i.,' !� �.�:t� � / ����^.""��...} ' �"�y�JtirdL���'J� € �4, V� �~��� ��, \ \�� r! �GJ
<br /> an�r7Authorfxed Agertt Signature ,. ���- � �
<br /> G a te /Tx'e�s�rsec�i.y%�.3�2d;',fij
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