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• � <br /> P�RMIT APPLICATION <br /> BUILDING I MECHANICA�/PLUMBING I SIGN /SPRINKLER/DEIIAOLITION <br /> CITY OF�VER�TT P�RMIT SEt�VICES <br /> 3200 GECIAR 3TI2�ET,EVERETT,WA 96201 <br /> (P)�426-257-6810 � FAX 426-257-8857 �(E}everettapa(�everettw�-gov� wvuw-averettwa.gov/permite <br /> Biue or Bl�ak [nk Onl Plsaso PROJECI' SITE INFORMATION � <br /> PROJECT SITE ADDREBS: � ^ PROPERTY 7AX#: <br /> L�GAL for new conatructlon: short Plat/aubdlvlalo� _ Lot No. (aflach copy of lona legal dasorfptfon) <br /> C�NTACT INRORMATION <br /> OWNER NAM�: TENANT NAM�(If Commercial : <br /> OWNER MAILING ADDRE95: sTrt�Et <br /> aTv % sT�rE zia <br /> OWNER pHONE: OWNER�MAIL: <br /> CON`CRACTOR NAME: C " <br /> CQNTRACTOR ADDRESS_ sTR��T � <br /> �,n g,��t tiP a� <br /> CONTRAC'TOR PHONE: 4 CONTRACTOR�MAIL: — ,,� <br /> CONTRACT�IZ UCEI�is�#(R�QUIRCD: CITY OF EV�RETT BU81NE83 L�CEN9E y►{RE�U�RED): <br /> pRIMARY CONTACT: ❑OWNER CONTRACTOR ❑07HER(Please Specify) <br /> CONTACT NAME: GONTACT PH41dE: �� �,�(, a <br /> ���� CONTAC'T EMAIL: <br /> BUI�D�NG PeRMIT APP�1cAT�oN <br /> Existlll Use of gulldln : Contrect Prlc�of Work:a U� � <br /> Pro o9ed Use of Sufidln ; Heat Sou�Ce: �as ❑Electrlc ❑Other <br /> Bu4ldin 7 a: ❑S�R-Detached ❑SFR-Attached ODu lex �Multl-Famil �of Unita: ❑Cammercfal ❑Industflal <br /> T e of Pro ect� �New 1�Additlon �Remodel �Re alr ❑T.I. C�SI n CaS rinkler ❑Demofltiflh C�Chan e of Use <br /> DESCRIPTION OF WORK: � � �� l�� ����L <br /> �pl�c�.n� � �1 � <br /> AS80CIAT�D BUILDtNc3 P�RMIT# If a licable : <br /> M�CkIANICAL PERMIT A�PPLIC/►YION PLUMBIN� PE�MIT APPLICA,TION <br /> Typo of PfoJoct: Now _ Add� Alf� tlo Ropair TypO Of ProJocl: _N�W _Atld11 !/4lteratlo� 12epeiY <br /> 8 of tlst ot Flxturea #of ��at ol�1 turQs #of ��st of FJxtures #of �Jst of�txtuna <br /> F�xturos Flxturas Fl�ur�a Flxturea <br /> AIC—Alr Handlin Units Heat Pum Tollet Backflow Preventar Inside 81d <br /> Forced Air 5 stems Unit Heater �ethtub Urinal <br /> Gas Pf In Boilar LavatO Wash 62sin) Drinkin FOUntaln <br /> Water Heatar Refrf eration Shower Floor Draln <br /> G�8 Flre lace Wood Stove Kltchan Slnk&Dis oe�l Greese Tra <br /> Gas Ran e Ductin DishWa6her Rpof DrBins <br /> Clothes D er Hooku s athar� Clothes Waeher Medical Gas <br /> Rd11 v Hood WAter Heeter OtFter; <br /> Exhaust Fen Slnk 5erv{ce/Bar/Mo /etc. Other; <br /> SPRINFCL.[R/8UPPR�SSION SYST�IIA <br /> Chemlcal or Water No.of Heads <br /> ACKNOWLEDG�M�NT:!hevs revfewed th(3 dpR(�cstlolt At1Q C0�(��fhe InloRtt6tlon cvntd771Bd hereln Js truo p11d comect.Wor+'�done pursuAn!10 thls permlt rtru:t camply with <br /> current lederel,alefe,and fOcal lew.Tlte g�nting ef tf ps�n only aulnorlres eppr'ovsd work end no devlstlons thersfrom.Devletions must flrst be eutAorfzed In wrrfin9 from the <br /> BulldMp O clel before erng eufhorizad under eny clrcumstanca,I am the ownar,or I am authorized by the owner of thls propeRy to perform(he w�k tar wnfch appl�Cation ia made, <br /> end!cam w11h th S te Co IS Law 18.27 RCW�nd 2BB.200A WAC. <br /> Clty o(Everett OIRCIaI Use Oh! <br /> PERMIT�,n � f� <br /> U � <br /> Owmr/A thorizod AOant Signature Date �vJsed 9/23/2096) <br /> T00� X�d OO��T LTOZ/90/Oi <br />