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PERMIT APPl.1�GATt�}N
<br /> BU1L�l1++�G 1 MECMANt�AL/PLt1MBIN�"'a 1 SiGM/SPRINKI.ER!DEMC?LIT'ION
<br /> CiTY OF E1fERETT'PEF2MiT SERVIGES
<br /> 32fl0 GEDAR STREET'�E1tERETT,WA 9820i
<br /> {P)425-257-6$10 j �AX 425-257-8857 �(E)avereiteps@everethn+a gov� www everettv�a.gavtperrriits
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<br /> PROJEGT SFTE AdDREBS: �,��S �•� �%K.*� .5"�' PRQPERTY TAX#:
<br /> i.EGAl for new consWction: Short Piatlsubdivision Lot No. {attach copy of lang isgal description)
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<br /> QWNER NAN1E• c..Y�s c.�.- Lh.2�C-�. TENANT NAME(If Commerciat};
<br /> UW�fER MAILING ADDRESS: ssRE� I��.S G '�c�.-�tn�� �"�'"
<br /> CRY 57ATE t,N` 21P �'�
<br /> OWNER P1iONE: Z� - oZ<�I � �� �� OWNER EMAIL:
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<br /> CdN'y'RACTOR NAME: i+� C'.�G+�' S �•-�G-
<br /> GflNTRACT012 ADDRESS: s�esr '�.� � {fa�t!'�. il��
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<br /> Ct?NTRAGT�R PHO�: ��—�'I Y�" 'Cl� GONTRACTOR EMAIL: t.�t9t'�S a:t $
<br /> CiTy pE E:YERE7T BUSlNESS I.IGENSE#{REQUIRED}: �
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<br /> PRIMARY G�N3ACT: �`3 OWNER CI C(3NTRAG70R Cl OTHER(Ptease Specify)
<br /> GONTAGT NAME: CONTAGT PHONE: - ��I I .. ��l�'7
<br /> �'t,K,Y'1 t�C.- c�j t.�it.�''lC. CONTAC7 EMAIL:
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<br /> E�astin Use of Bu�ldin : Coalract Price of Vltork: �Q �
<br /> Proposed Use of Building: Heat Source: LlGas �Electric ClOther
<br /> Suiidin T e: ❑SFR-Qetached ❑SFR Attached �Du le�c ❑Mu1ti-Famii -#of Units: ❑Commerciat ❑IndusVial
<br /> T` ot Pro' ct: ❑New ClAddition �Remodef ❑Repair CIT.I. ❑Si n ClSprinktet ❑Demolition Chart e of Use
<br /> DESCRIPTION OP WORK:
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<br /> ASSOCIATHD BUILDiNG PERMIT# �f a icabie
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<br /> Typ+e of Pro eci: Nsw Addn :,Att�ration `Repa r
<br /> of Project: _New, Adda Aiteration;_R$pair �
<br /> #of #of #of List of Fixfures �of List of Ftxtures
<br /> F7xtu�es Lisf af Ftxtures Flztures Llst of fixiures F7art�res �lxtures
<br /> �11C—Air Handiin�Llni#s Heat Pump Toilet Backfiow Preventer{inside Bldg}
<br /> Forced Atr Systems Unii lieater Bathtub Urinat
<br /> � Gas Pipi Boiler Lavato Wash Basin Drinkin Fountain
<br /> ' Water Heater Ref�i�eratio�► Shower Ftoor Drain
<br /> Gas Fireplace Woad Stove Kitchen Sink 8�Dispasal Grease Trap
<br /> Gas Ran e Ductin Dishwasher Roof Drains:
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<br /> Clothes D, er Hookups Other_ Ciothes itiasher Medical Gas
<br /> Ran e Haod Water Neater Other.
<br /> Exhaust Fan Sink ServicaBar/Mop/etc. Oiher:
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<br /> ��Ghemica{�o��Waier. .. No.oftieads _ �� � � �
<br /> ACKNON2EDGEMENT:f have r�viewed this applicadon and confirm ihe information contained herein is true and correct•4Nork dor+e pursuent to lhis permit must comply with
<br /> cu�rent federat,sfate,and/ocai law,The grantirrg af a permit orrlY aulharizes approved work and no deviations therefrom.aa�aGans must�+rst 6e authorized fn wrfting fiom the
<br /> Builtling O�ciai beForo being auihorized under any c�rcumstance.l am the owner,or l am st�t'horrzed by the owner of thls property to perform the wrork tor which eppticetiun is made,
<br /> and t compty vdth fhe State Contractors taw i$.27 RCW and 296.20�A WAG �ny p{Evereit Officiai Use Only
<br /> �— �I�—t t PERM!'�/�fn I� ��/ ��
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<br /> OwnerlAuthor ent 5tgnature Date (Revised 9/23l2016}
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