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PERMIT APPUCATION
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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> - 320D CEDAR 51'REET,EVERET'C;WA 98201
<br /> (P}425-257-8810 ( FAX 425-257-8857 �(E)everetteps a�everettwa.gov f wwv,l.eu�rettwa.govlpermits
<br /> 8���or Biack�nk.���°�!�,�� PROJ�CT SNTE IN�'ORMATION
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<br /> PRO.�ECT SITE ADDRESS: 7' , , ��,�;#,�,� " PROPERTY TAX#:
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<br /> �iG�:for new canstruction: Short P�a�'�bdi�isk�ct �t No. (attach copy of lo�rg tegaf description)
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<br /> CONT%►CT INFORMATION
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<br /> OWNER NAME: ' ��''+�- ;�,��� '� TENANT NAME iF Commerc�a�};
<br /> OWNER MAIUNG ADDRESS: srrae��- � �_ . ��'I� �,`�"'>
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<br /> CITY �� �, .,: ��� �. .. . STATE ._W� ...ZIP ���.. �'.
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<br /> OWNER PHON�, ZLxi �-�'ZO ��� OWNER EMAIL: :
<br /> GG1�+t'f1�AGT�R NAME; ,' ,
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<br /> ��3FtTt�AC'i`qR ADDRESS, s�aeer ` , � _ �«.
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<br /> �C3NTRACTOR PHONEB �� �" �, �.� � � � : �� ,
<br /> � ;., . CONTRACTOR EMAfL: _ ""�°� , J�'NYLI.•LQG2."�"7� . � ts�:�� ',
<br /> CONTRAG..TQR UCENSE#(REQUIREp�. ��� ' �"� "Z:�� ° CITY OF EVERETT BUSINESS LICENSE;, �,t��k���:. ��1�
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<br /> PRIMARY CONTACT: �OWNER � t;��.('���p�, ❑OTHER(Please Specify}
<br /> t)hl'�'llC'C:N�tNf� k �Q�`tl�'i`PHONE �t�„'t -�z�.�`
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<br /> ��3�,{�'��'�'EMAIL:
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<br /> BI�ILt1!ING PEI�MIT> pL ... `I'I�N _
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<br /> �xi�ti� Use'of Buiidln"� Contract Price of W.arka;� 5op
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<br /> ��r�`' ��d Use of���d�i�s � Heat SourGe; ❑Gas t�C�° �Other
<br /> B�i��fr� '� .eP �t�:�5�€�ehed __�75FF2 Attached Cif�u,I�� ❑MuNt+;��ri�{I of Units� ❑Commercial �Industrial
<br /> 1'.;p�of F'ro eet. ❑New
<br /> �+�s ❑.R..emodel..: �F� ;�u�`: ❑T.I� �� •t�. Q. �it�kfBr ❑Demolition ❑C��1 �;of Use
<br /> bESCRIPTION OF VitQRtf:; _
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<br /> ASSOCIATED BUlLDING PERMIT#:'�� Ii���; �,(CpI Z^m�e,� '� '
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<br /> ��w�� � -� zes�d+e�►�t�c'a.�.�
<br /> IY��!��a�t��: a�'�!� .,. 1"r`�!���.�',1"�+�t� PL�t�E�IN�� ����"�",�!i�!���,�1►"TION
<br /> Type pf ProJect; �New Addn `Alteratlon _Repair Type of Project: _New _Addn _Aiteratlon _Repalr
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<br /> Flxtures �fst of F&tures �°� List of Ffxtures #°f Llst of F/xtures #°f Ltst of Fixtures
<br /> Fl�ctures Flxtures Flartures,
<br /> A/C—Air Handlin Units "', � Heat Pump Toilet Baakflow Preventer(fnside Bid }
<br /> Forced Air S stems Unit Heater . Bathtub ��(
<br /> _ Gas Piping Boiter ' _
<br /> - Lava#o {Wash Basin} Drinking Fountain
<br /> Water Heater Refrtgeration SF�ower Floor.Drain
<br /> Gas Fireplace �Noad Stov� ` Ki#chen Sink&Di..s osal Grease Tra '
<br /> Gas Ran e Ductin' Dishwasher Roof Drains
<br /> �It�#h�C5 er Haoku s Other. ' Clofhes VVasher Medical Gas `
<br /> ►Y P
<br /> �an e Hood Water Heater Other:
<br /> Exhaust Fan ` Sink"(Service/Bar/Mopletc. Other:
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<br /> iCKNOWLEDGEMENT.•I have reviewed►his appJication and cont)rm the iniormation coniained herein is irue and coneci. Work done pursuani to fhis permit musf compty with
<br /> unent federal,stafe,and local faw. The granfing of a permit only author/zes appioved work and no deviaGons therefrom.Deviations must flrst be authorized in wrrting fiom 1he
<br /> �uifding O�cial 6efore being authorized under any circumstance,t am ihe owner,or I am authorized by ihe owner of this properiy ta perform the work for which applicntion is made,
<br /> nd/comply with the Slate Confractors Law 18.27 RCW and 286.200A WAC.
<br /> �t�of Everetf Ofilciaf Use 0�11y.
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<br /> �" tt �iJts�fh�rrizeiltAgent Signature " ` Date !
<br /> (R�V'�tIi�3r'.2f� )
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