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<br /> P�I��➢I�'�P�LICA.�`l0�
<br /> f :�. �i�dLC�1�1�I��CH��9IC�1�..I�'l.l.���fi�16�I�I�1��9 I���9t��CL�R 1@��I�d����'�C7
<br /> � '_ CITY OF EV�RE�1-f'PERMIT SEf�VICES
<br /> � 3200 CEDAR STREET,EVERETl',V�IA 98201
<br /> (P)425-257-88'IO � FAXQ25-257-8857 �(E)everetteps@everetiwa.gov� www.everettwa.govipermifs
<br /> ���'nr-�i�,���ii�'�`�71�II�"�G3��ii'B�_i�7. " • � " - . - •-�
<br /> ��a�3y G'�l�21�ce� :��Q���.. .� . . ..
<br /> ���du�.;�.�'(�d��i',���I�� ,� . � ' PROP�RTY TAX�:
<br /> PROJEC75ITEADDRESS: � L� _ � �
<br /> �Lot No. (atfach c�opy�[long!eqaf descriptlon)
<br /> — — ---------`.
<br /> — — — —
<br /> LEGAL for new ccrstruc6o�: Shor�PIa#/su6divis on _ _ — ••
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<br /> "�'��`� ` --- � �-"-�'' �/'�!,J TENt�t�7 NAiVIH(If Commercial):
<br /> D}Ni�fER�IAPZC-: �t,
<br /> OWNEE2 ritiAlLIhIG ADDRESS: srREEr .�.��OU G�'
<br /> STATE l��
<br /> CITY
<br /> 011V�IER�fL7Af[,: .,�.... ......�....._..._.:.. ...,..
<br /> 01(V�ER PHO`dE: .......... ....... .— _
<br /> CO�ITRACTOP�IA�v7L; ,L�7L=i l v�'�J ��nt ~.�.��L.
<br /> STftEET 2.-L�O ;�-C-I.T C.�
<br /> GOf�1TRACTO�ADDRESS: srnTa �..l,� ZIP ��a �`
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<br /> coriT�croR Pxot��: (tt-Z5 25Z-- ;�a i�'-1-
<br /> COiVTRAC'I'OR�I�'fAIL: t°��/'�O-���"�Z`-✓Gc:_=C:i�FLS
<br /> CITY OF F.VERETT BUSIIVESS LICE�SE#(R�.RUIREA}: �'j ^ , �.-__
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<br /> COA]TRACTOR LICEfVSE�(RCQu1RED . ,., . .--.Y.- , ., _ - -
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<br /> PRIMARY CONT�CT: ❑flWNER `�CDNTRACTOR ��TCDNTACT PH4t1E:�>
<br /> �Z� ,5�e�s�-t�`7 Z"�
<br /> CONTACT NAM�: ' '
<br /> CON7ACT E1NA1L: '���Q�/�v�Sjy'JGf.��'�•��
<br /> �1-�i� �z—�' . . .: . ... . .. . . .
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<br /> , • ,. ,: . . - BUlLD1NC�.P�RMI�'.,A�PRICA.:'�`[ .
<br /> -- - Contract Prfee of Work:a�
<br /> Existing Use of Building: —
<br /> Heat Source: ��Gas QElectric ❑Other'
<br /> Proposed Use of Huilding: ❑Commerr,ial ❑Indusiriaf
<br /> Bui[ding TYPE� ❑SFR-Detached ❑SFR-Attached �Duplex ❑tiTulfi-Famify:`of Units:
<br /> Type cr"Pro}ect: ❑Nevr LZAddition LlRemodel ❑Repair QT.L ❑Sign ❑Sprinkier ❑�m�t�� ❑Change of Use
<br /> DESCR[PT10N�F WORK: � �5`--��� �/� �/�t�" �l� �� ���- cvi�l �.�/�`��C.-
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<br /> ASSOCIATED E3UlLD[NG�ERIY](T 7r(!f appllCBble)� - - ' ��_������ ����p��������,�.���=—__
<br /> �� .�611���`�A��.��_ .�'�__.____-�__����fl�'����'���``r1i�,�{ _ 7yPo oi Proj ew _ftddn �_rs.Itarafion __�_.____
<br /> lype oi Projec{; _..�e4•J _.— Ad��� —AIfP�'aEicn ,.Repair r,?oi' �.ist os I-'ixfures
<br /> �ap �°� List ofFixfures ��or L.ist o�'�ixtures FJ�fures
<br /> List ofFixrures Fixtures txiures B�ckflcw Preventer(lnside Bldg) .
<br /> Fixturas Neat Pump Toilet -.-
<br /> A,`C-Air Hand!ing Un�ts �a����b Urinal
<br /> ;orced Air Systems � Unit Heater Drinking Fountain
<br /> �ciler Lavaiory(V'�lasfi Basin) F�Qor Drain
<br /> � Gas Piping ' Shower
<br /> Re i rigeration Grease"T'rap
<br /> Water Ijeater W�o�Sfove Kitchen Sink&Dispasal
<br /> Gas F replace bishwash�r Rooi Dra;ns
<br /> Gas Range Ducting (�q�dical Gas
<br /> flther: C!othes V'lasher
<br /> L(p�}�es Dryer Honkups Water Heater Other.
<br /> Range H�od Sink(ServicelBar/v;op�etc•) OT����:
<br /> Fxnau_____ St Fa�
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<br /> IE����L�!�lY��'�€iFl: .
<br /> �k��Y����:�./��PPL�..--� — ' —
<br /> L�:r':: .. ._..___—_i�lum�erofHeads.., — —_
<br /> �--_-�"=_s�---
<br /> ACIUVGWLEDGF_MFNT.'1 have revlewed fh/s applica±ion and coni�rm the iniormat�ion���n'%and'� �aviarrbns fhere�om.tGevrations�st r;rst be au�ti-,onzed imu���l J�on the
<br /> currenf fede�al,ste?e,and lor,al law. (he grantinq Qf�Pp1i7'tf enly aufhorizes app
<br /> Jicaiion is made,
<br /> Qurlding Ofi9ctalbefore being authorized under�ny circumsfance.I am the owner,or!am�uti�orized i;y iho own�f cf fhis;�ropety fo porPonn tfrc�workfor whic i aPP
<br /> Cify ofEvererf O�cial Use OnlY
<br /> and 1 r,cmpl,�'✓�'it�i the Stafs Ccnf;ectors Law 18.27RCW and 296.200A'✓�AC_ — _
<br /> �PFRM1T�l' / o��D —�!
<br /> - _ - / �[�— � � -_ �---
<br /> Gs:�� � � /� �Revised 5/2 %ZG96) .
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<br /> 7�,vr�er/Aufhor!zed Agent Signaiure
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