|
����r�r,�p��.ic��'io�
<br /> �UIL.� � I IVi�CH,4iV➢C�4L.1 Pl...UiVIBIfVG /SIGP �PRINK�Li�R! f�F�iOL.ITION
<br /> � CITY OF EVERCTT PGRMIT SER��
<br /> 3200 CEDAR STREET,C-.VERETT,WA y8201
<br /> (P)425-257-$810 � FAX�}25-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govlpermits
<br /> _ . . _ ... . . ..... . ...:::...... . ... .::-:::....:,..:..:::-.... ..:_. ,....:.-:..__:-.- �.:.:_--=..._...:..._:,;::�.:,...-.::_•-:_;.<:- :_.:<,;;..;::�:,:.:_.-.;:;;;_:;;::;::;;;:.�': _ ::':�.::.:`.. �..
<br /> _.. _
<br /> -;:.;_::.:__,�: .:::;:.<_ :.::.�:=._=P}ZO��GY_SIY��IA�FOR1VId1Tl,01� . ' �
<br /> .;:: : _.._.:..,-_•.-.::::; =::._:.,�:: ., _.:. ,.
<br /> PR�JECT S1TE ADDRESS: ��5 �� PROPERTY TAX#:
<br /> LEGAL for new construction: Short Pla subdiv io
<br /> � Lot No. (attach copy of long legal description)
<br /> , _ _...::.......:.:.::.-:....:....�:- ,:. ._ - - = - - _ - - = -- - _- - - - - _ _ - . �
<br /> •-...•......._.. . .�...: ,.. . - - - -
<br /> �..:: .:....:::...::_•.:•:,....;::.:.:. . :'<°.,, `
<br /> :.. : . ....::..:
<br /> .:.
<br /> . .:.. ::.....�;; ,,;.._:::• .. ..::._ -
<br /> . ,�...,;.:::.:. .::: ..::..:::.... ....:........::...: ,•.:. .:,._:.:::,... ....:• ..,:: .:.. ..:.:.� :. --..:
<br /> ::,_. ...: .... :....... .. . .:. :...:... .-. . .. ..:,...__. .:,,.;:.:.;��;:::�.COY+1Td�4Y_�IN�O..R.MAT1ORd_>;�`_:::::'.�.',.'.-�..,;`;..�:.;:::•`:;;�. .....: ::'.:;:,..::.:: . �..
<br /> �.:.....:.....,:.::::,._..:: .::..... ::.. _.. .. ..._ ..,
<br /> OWNER NAME: �f'1� t- �Y?�� �[ TENANT NAME(If Cammercial):
<br /> OWN�Ft MAILING ADQR�SS: srRr-�' 3��S Q
<br /> CITY �V STATE ZIP /-g L�
<br /> OWNER PHONE. yZS Z��'��!/� OWNER EMA1L: cSU Q/� �� ►'C'(� 4 d •�1��rn'
<br /> CONTRACTOR NAME: (� 11
<br /> CONTRACTOR ADDRESS: srReEr
<br /> ��N STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTQR LiCENSE#(REQUIRED): CiTY OF EVERETT BUSINESS LICENSE#(REQllIRED):
<br /> PRIMARY CON7ACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTAC7 PNONE:
<br /> CONTACT EMAIL:
<br /> ... _ ._ . .._..._ .._:::�:::.:.:_:.....,=_:,.._:-�...:�.:,. ..__-_..:._:_.•,:_:.•_..,,._-___.<::::_-•,:,.._.-:._:-:_,.,__,_,-:-_-_�.,.;_.:::_,.__::_:'_�:_=i�=:�'T:-':=-=�:_-;;�::;::":;--�:..;-_':�^_':.:'. -' ' -
<br /> -_ _.::.-..._.___ . � - -
<br /> �..:.-. .:_.-:-_. � �<:_.�;-=°.-. = BU_[LDIN�P�ERM1�'APPL`CCATION;-:_;_:.-._;:;.-; . _ -
<br /> �..._�.
<br /> _:_::.:.:. �=_.:_:-.::;::=�=-°---,.:::�.:._:. �.-:_•... . ... _..._.... ..
<br /> Existing Use of Buiiding: � Contract Price of Work:$
<br /> Proposed Use ofi Building: Heat Source: C1Gas ❑Electric �Other
<br /> Building Type: ❑SFR-Detached C1SFR-Attached I�Duplex ❑Multi-Family-#of Unit�: ClCommercial Cllndustriai
<br /> Type of ProjeoY. C1New I�Additipn 17R�modei �IRepair �1T.L �Sign �Sprir�kler C1Demqlitia� C1Change of Use
<br /> DESCRlPTIOtV OF WORK:
<br /> pcmo o-� exis�'iYl,{�. o�a��-e. $ �o�h� D�- �v�nd��'i��t � smal �
<br /> U ,�-W1 0+- C�►ZcV2
<br /> AS50CIATED BUILDING PERMIT#(if applicable): �
<br /> -• :...: ,,;:::;. :::_.:.:-:..,_�--�:_-:.•,;..,___.,:.. _�.;..._...__�:-;. - : ,_.:_.:.,.. . . . - - _ .
<br /> MEC:HANI�AL PERMITAPALIGQTION: ;, . '. : � . ;..•��::PLC)Nt�IN�. MI7 PCICATI �
<br /> PER '.AP ON.
<br /> . . �
<br /> Type of Pro�ect: ,_New Addn _Alteration _Repair Type of Project: _New Addn ^Alterafion ,_Repair
<br /> #of ^ #of #of List of Fixtures #°f List of Fixtares
<br /> List of Fixtures List of Fixtures Fixtures
<br /> Fixtures Fixtures Fixfures
<br /> A/C—Air Nandling Unifs Heat Pump Toilet Backflow Preventer(Inside Bidg)
<br /> Forced Air Sy$tems Unif Heater Bathtub - Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heafer Refrigeration Shower Floor Drain.
<br /> Gas Firepiace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Sar/Mop/etc.) Other:
<br /> . .._....,. :__. _:: ...... : ..... ._ ..._..._.;..._.: ..:::..:_..: ::...__.._ :. .
<br /> :: ,�:;;�'•.SP;RIPI�CL�R:;/:�UP;PRES:SIOId`'SYSTEM:-,;_:::��.-
<br /> Number of Heads
<br /> ACIWOWLEDGEMENT.�1 have reviewed this application and confrrm the information contained herein is true and correct.Work done pursuanf to this permit must comply with
<br /> currenf federal,sfate,and locallaw.Tfle granfing of a permit only authorizes appr9ved work and no deviations therefrom.Deviafions must frrst be authorized in writing from fhe
<br /> Building 0fficial6efore 6eing authorized under any circumsfance.1 am the owner,or 1 am authorized ky the owner of this properly to per(orm fhe work for which application is made,
<br /> and 1 comply with fhe Sfafe Contracfors Law 98.27 RCW and 29S.2ooA WAC. Cify of Everetf Official Use Only
<br /> PERMIT I � �r.,�
<br /> � � � / '�
<br /> Owner/AuthorizedAgent gnature Dafe (Revised 90 2095)
<br />
|