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III� PERMIT APPUCATION � I'I'
<br /> BUiLDING F-N�CHANICAL/PLUMBlNG/SIGN /SP�lINKLER/DEMOLITION
<br /> - CITY OF EVERETT PERMIT SERVICES
<br /> - 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (F'},425-257-8810 � FAX 425-257-8657 j.���,everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT SI7E ADDRESS:.,.. Q�Q_,, , }� . SW PROPERTY TAX#:
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<br /> IEGAL for new construct(on: Shart.F'I�tJs�tbdlv�sltsr� Lot No. (attach copy of long legal description)
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<br /> CI�1�R NAME: ,;. �;•�,�� ,�ji� TENANT NAME t�.�c,►�tt�nerc�a�l},
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<br /> Cti�!'�ER MAtLING ADD.RHSS: sraeeT ' Q'�'ti'1 -. _ _
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<br /> CITY „irw� , STATE.. 21P �Q'' .♦ , .
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<br /> OWNER PHONE: Z. �',� ' � OWNER EMAIL: _ _.. _
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<br /> CONTRACTOR NAME: �'"���'"'��
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<br /> CONTRACTOR ADDRESS: s�eer '�I� � : _
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<br /> CRY . STATE - ;� ZIP i✓���
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<br /> ��Fi�'1'fi��'�'C}�.PHONE : . ° : -
<br /> �Q : GONTRACtOR EMAIL ; . �%��,�','��'�. �CD�"�'I
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<br /> C�3�'dTRACTQR LICENSE�(Ft�itt���;CM�'P,(�,�,�i�'L�`�TZ�J#'`� �PI`�'OF EVERETT BUSINESS LICENSE:.���lt1l��Cf�; � ,
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<br /> ; .�E�t�lA1�1P GONTACT: [7 OWNER CONTRACTOR ❑OTHER(Please Specify) _
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<br /> �Q�ITACT NAME: CONTACT PHONE
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<br /> CONTACT EMAIL; �t y{� , (',/h�;��j��'i .�p M
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<br /> �xistin Use of Buildin : ,...., Contract PrEce af Work.'� :� `
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<br /> proposed Use of Bufldin : _ Heat Saurce: as ❑Electric ❑Other
<br /> �utt+�i '�' �. ��R FJ�e�h�1; ❑SFR-Attached �D� l�t� ❑Mufti=��rnii =#"� �rr(ts: ❑Commercial ❑Industrial
<br /> T. e of�tt� �t:<�New �Addition ❑Remodel C��� �� ❑T.I. I�#� €� ❑, i.nkler ❑Demolition ❑Cha " �;of Use
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<br /> l�k3�Q�tllT�D BUILDING PERMIT# if�1 "!#��{�:";
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<br /> ECNANiCAL.P�RI411T AP.�:I�p"�"�tiN; �.L1,�M�1�IG pERMIT A#"P41CAT�AN
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<br /> 7ype of ProJect: _New _ Addn ,Alteration _Repair , ; Type of Project: _New _Addn _Alteratfon _Repair r
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<br /> Flxtures ��st of Pixtures #of Llst of F)xtures #of Llst of Fixtwes �°f Gtst of Flxfures
<br /> FJxtures Flxtures Flxtures
<br /> AtC-Air Handlin Units" ` Heat Pum `: 7oilet �ackflow Preventer Inside Bld !
<br /> Forced Air S .sfems Unit Heater `' Bathtub:: ' ' Urinal
<br /> Gas Pi in Boiler L�t "'; ���=��s� �rinkin Fountain '
<br /> 1Nater...Heater :: Refri eration 'Shower Floor Orain ` '
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<br /> Gas"Fire lace ood:Stove k�fi�t��::Skt�-.� >t��a[: GreaseTra
<br /> �as'ftan e ` ,, T3uctirl C�ishwasher ' _ Roof Qrains
<br /> Clothes Dryer Hooku s `�J'ther. Clothes Washer Medical Gas
<br /> Ran e Hood ; Water i�eater Other:
<br /> Exhaust Fan "` Sink Service/Bar/Mo /etc. OtF►er.
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<br /> � �R��� �'���$1�1� $"1�7"�...� `' ...i
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<br /> Chem(ca.l.or WaSet_ No.of Heads ;
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<br /> ACKNOWLEDGEMEN7.•I have reviewed thls appqcafion and confirm the lnformalion contained hereln is true and correct.Work done pursuant to this permit musi compfy with
<br /> cunent federal,state,and local law.The granting of a permif only au�horizes approved work and no deviatlons fherelrom.Qevlatlons must firsf be authorized in writing from the
<br /> Bulfding Olfic/af before being authorized under any clrcumstance.I am fhe owner,or t am authorfzed by the owner of thls property to perform(he work for whlch appficatlon is made,
<br /> and I compfy wNh the Stafe Coniractors Law 18.27 RCW and 29fi.200A WAC.
<br /> C�`!y of Everett Olficial Use t�rtt��
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<br /> �1t4+�t�rt,Autltiet:rtx�9.Ag�s���ignature _ Date �xt� ..., �`a',��7�,�.:
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