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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P}425-257-8810 � FAX 425-257-8857 ����°sveretteps@everettwa.gov� www.everettwa.gavlpermits
<br /> ���ii�`��r Black ink E3tn ,;��a�e ,.:..: PRQJECT SITE INFORMATI.ON ,:,.
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<br /> PROJECT SITE ADDRESS. �I � G7✓P./� PROPERTY TAX#: '
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<br /> LEGAL for new construction. Short Pt�.st�6:r�3x�5u�r�. <.,�.r�i.No. (attach copy of long legal description}
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<br /> `��.��-;_ .�;�ONTACT INFORMATION '
<br /> OWNER NAME. ' :�
<br /> ' � '.. �t TENANT NAME �;GQmran��t��j: , _.
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<br /> OWNER MAILING ADpRESS: srReET � ' ' '
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<br /> �WNER PHONEn`: � , ,-.,' ` ' OWNER EMAIL•�,_
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<br /> GQNTRAGTQR NAME, �, ,,. � ,
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<br /> GONTRACTOR ADDRES$a� STREET . � �; ` .
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<br /> _.. CITY`.. . . .. . . .. � `''� �� . ..__.. S7ATE,.... ZIP . .
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<br /> CONTRACTOR PHONE: , ;� : GONTRA�TQR EMAIL�.: .� : . ` , '
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<br /> �a'l����;�'�,�°��"LICENSE�3��C��,II,IIFi�� ' : ' . �, ! � „':,_ CITY OF EVERETT BUSINESS UCENSE#(REQUI,,. ,��: �
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<br /> f'Ii1MARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify} _ ___
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<br /> ; �*��+IT'A�1`NAME:.. CONTACT PHONE ��j ��� ����
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<br /> CONTACT EMAII;' :
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<br /> i . ��ILD{NG PERMlT APPLIGATCQN' '
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<br /> Exist', Us@ of:6�, . •: C9ntraat.Pr�ce of.V1(ork: - A t. .
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<br /> ; P"r�i� sed Use._of Build` ° _ ...... _. H.eat Source _ ... �Ele�tric (�.qih'e,r
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<br /> 6�ti�t�E "°T' �: , $�#������3St OSFR-Attached D�Ju tex , �Pi�3itEfi-��r��� ', of Units:• ,�Commercial ❑Indus�rial
<br /> `G. ,•of R��t��#;: C7New ❑Addition ❑Remodel 5.. `�, ' :
<br /> � _. ❑T I, �I��;n ❑S�ri�tikler ❑Demolition O��t" of Use
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<br /> DESCRlPTION OF WORK: _ " __ _ _
<br /> RQ�IA,G� A,5 -�v rn.a�_
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<br /> i A���C1�+"CC�I:BUILDING PERMIT#�i�;" icable�:
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<br /> � MEGH.pMI.CAL PERMIT APPLICATION ; PLUMBING PERMlT APPLtCAT10N
<br /> '7ype of Pro�ect. �New _ Addn �Alteration ,_Repair Type of Projecf:. �Naw _Addn _Alteration
<br /> , _Repair
<br /> #of ,",, . ,::. . #of _. .
<br /> #of List of Fixtures #p� Ust of Ftxtures List of Flxtures List of Fixtures
<br /> Flxtur..gs, ,. Fl�ures Fixtures Flxlures
<br /> ` p : '.. ;;:�°Toilet '::: . ;; ;;;. Backflow Pre�enfe� Inside Bidg� ;
<br /> NC�'Atr Hand..lin Units . Heat Pum
<br /> �� Porced Air S stems Unit Heater`, " ;'Bathtub"',' `" Urinal. '
<br /> `Ga§ i i Boiler ' 'avator Wash Basin Drinkin Fountain
<br /> Water Heater ' Refri eralion ; ;Shower � floor Drain
<br /> Gas ire lace'' WQa�t Stove"' Kitchen:5irik&pis osa.:: Greass Trap
<br /> Gas Ran e Ducti ; 'Dis wasfier '� "' ° Rotif Drains""
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<br /> , Ciothes D er Hooku}is Other: 'Clot�ies V1�asher Medical Gas
<br /> , , " "_ Ran e Haod " ::.. _ .': _,Wafer Heater _-. Other. �
<br /> Exhaust Fan `;5ink{Senrice/Bar/Mo letc; ";, ;Other.
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<br /> SPR[NKLER/$UP.PRESSION SYSTEM "
<br /> Chemical or Water No.of Heads
<br /> ACKNO WLEOGEMEMfi!have reviewed thts app!lcalion and confrrm the informaliort cont8ined herein is true and correcF Work done pursuant to this permit mus!comply with
<br /> current Iederai,sfata,and/ocal law.The granling of a permif only authorizes approvad wak and no devtations fherefram.Deviatrons musf iirst be authorized in wri�ing from the
<br /> BuildJng O(liclaf belore belny aulhor/zed under any circumstance.t am the owne�or 1 am aulhorized by the owne�of this pioperty to peAorm lhe work for which application is made,
<br /> and I cromply with the Sta�s Contreciors Law i8.27 RCW and 296.200A WAC,
<br /> City ol Everelf pfficia(Use Onty:,:.
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<br /> C1YNt1�f��u, �e�!A9ent Slgtii�tl;.:,,: <.; Date �Ret�Fs�if;�� 16)_ ,,
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