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<br /> 1'� ��; �,,,�� 3200 CEDAR STREET,EVERETI', �
<br /> -'�---=>'� (P)�25-257-�� FAX 425-25I 8857 �(�}evere�Eeps@everef�`�� ��%�.everetfwa.gov/permifs .. ,. .
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<br /> PROJ�CT S1T�I-�DDRESS: ��J G�J� ' ��J l t'� ;� ��-�-
<br /> Lot No (affach copy of long fegal descripiion)
<br /> L�C,AL ior new consfruciion: ShorE P1aJsubdivision __ _ -_ -- _ ,.. . . .
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<br /> -�---=.-- .� . - ' �- �/,/���� :.. -•/��� �' i Ei�AN7 vA�IfE(I;Commercial}:
<br /> O1/UI�I�R�TAM;: �•�2. b�r2 b C _.
<br /> 2G.� /2 �-�L�'��<< �� l
<br /> OUIINER t�(AiLIN�ABDRGSS: srRE�r ziP �l�� ��
<br /> •� STATE l��>�
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<br /> G01�ITRAC i OCti ADDR�SS% S'iREET 7-►.ZC? ��"���L-'
<br /> STATE ��,a ��� ��� �
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<br /> COl�1TRAGTOR PHONE: ��Z'7 ,r�
<br /> 'Z i Z-- .�[(�-{- CO[�ITRACTOR El�fAIL: 1-�-tJ�'�-�.���5 GYi t,✓G:.=C.%J Ft'S
<br /> UIR�D �
<br /> (CI7`f OF EVERETTSU51AfESS LICEi�SE'r(R�Q � tdj� f
<br /> coNTRACTOR LICE�is�#(REo.uiPrD} ��-„�2�:��sc�r� ���-s�
<br /> PRIl41ARY COVTAC i: 'f��WNERY �COAITRAC70R ❑ OTHER(Please Speciiy)
<br /> CON7'ACT PHO�1C: ��z� ,��,� —U�7�:2
<br /> C�NTAGT NAM�: • .
<br /> COMiACT EMAIL: '�r�-p��'Sj7�I�-1,��.���''��
<br /> �L��� 5��� . . . . . . . . � _�.
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<br /> . . - .. �-��uiLDrrs � _ .. . -
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<br /> -- ' Confract Price of Work:� :�� ���� ,
<br /> �xisting Use of Bui[ding:
<br /> Heat Sourca: f�as ❑Electric ClOther
<br /> Proposed Use of Building: F �ommercial ❑Indus�rial
<br /> Building TYpe: ❑SFR-Deiached ❑SFR Aiiached ❑Duplex C7Mulfi-Famify�:-of Units:
<br /> Ty}�e of Projeci: ❑New 17Addition I7Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demoli�ion ❑Cha���j�
<br /> D�SCRIPTION OF WORK: ��1�1-%(�(-.. ��C--C�Z ) IiK(��lf-�k� (f1 �-c �T C��{��C�~Z
<br /> . ____---_`_
<br /> 4SSOL'1ATED BUILDI�IG PERN1fT�(if applicable}: - - --- - -- • , - -
<br /> - � ; ' �l�'d''����k�l�,;���`�a�L��( _
<br /> __---- - --- ,. ' 1�141�J;1�i�.RG�d� [P��;Cv€. . _ - :. ._--_-_ "..---
<br /> ..:• .'; �IllI�:�1+"-�.�R1���1F�:F?��'•h�.11H'If���''.Pp�[fi�;��`�'��,�9� �__ . ' ' ' -=====Nev,r _.-Addn _TAlteration _,Renair
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<br /> �=:.____.__> -=- � Type o�Project: _
<br /> �Ype oi E'rojeci: _IUew ._ ELddn ____,AlferaEion _.Repair
<br /> µa f '`oT List o:Fixiures 't°r List o�'Fixfures
<br /> �oi Lisf of.Fixiures � List oi Fixfures � � Fixfures
<br /> Fix�ures Fixfures
<br /> t=ixtures i oifei Backflovr Preven�er(Inside 131dg
<br /> Heat Pum Urinal
<br /> �q/r_f�i�•Handling Uni�s ! �' — Qa�hiub - ----
<br /> Forced AirSYsiems Uni�Hea�er , DrinKing FounEain .__
<br /> � �Boiler Lava�ory(�I�lash 13asin)
<br /> �Gas Piping Snower FloorDrain
<br /> Wa�er Heaf�r iZe�rigeration Grease Trap
<br /> {<itci�en Sin!<&Disposal � I
<br /> Gas FirePlace VVood Stove Rooi Drains
<br /> Dvcting Dishwasn2r '
<br /> Gas Range �Clothes VVasher N(edical Gas —�
<br /> C(oches Dryer Nookups Otlier: " �i�later Hea�er fl Other. ---�
<br /> e Hood O�her: I
<br /> Rang Sink(ServicelBarhUlop/e�c.) I
<br /> C-:xhaust Fan�
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<br /> _ —N m�er of Heads _-------------_=-_—
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<br /> �-rV1F_NT(have reviewed ihis application and coniirm ihe inrormaEion conh�2n��o dsv�rio s th�rE�om.�17��a,fions mustrr'rsf be aurhorized rn writiny T o��the
<br /> CKNOWI_EDGC
<br /> lrrenf fedei�al,state,and locallaNi 7 he granting oi`a permit only aurhon�::s approved
<br /> uilding O�ci21 before being aufhonzed under anY°�c�and 29�.200A 1VyACne1 or!am au�horrzed by�h�ov✓ner of rhis properiy to perfnnn rhe tvork for V✓hich applicafion is ma e,
<br /> �d/comply la�rfh the Sfate ConfrGcin�s Lai�✓98.2%(� _ Ci�y oi Eve�etf OfficiaJ Use Only
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<br /> PERIUf��j,� �� I
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<br /> �,�� _/� - 2�� � -- .
<br /> � (Revised 5/20/2016)
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