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PERMIT APPLICATION
<br /> BUILDING �CHANiCAt./PLUMBING /51GN 1��fNKLER/ DEMOLITION
<br /> CI7Y OF EVERETT PERMIT SERVICES
<br /> 3200 CEQAR STREET,EVERETT,WA 9&201
<br /> ,.
<br /> (P)425-257-8810 � FAX 425-257-8857 I{E)��ar�t�+�p�����jr��w�q�y�� ,,�.everettwa.gav/permits
<br /> ���ue ar 81ack lnik�1��y Please�" PROJECT SlTE tNFQRMA"TItfN
<br /> ��C��lECT SITE ADDRESS: � � , : _
<br /> : � ' . PROPERTY TAX#:
<br /> LEGAL for new construction: Short pl��stt�r�itv351�tt� ' " - --
<br /> �qt•Na. attach co
<br /> ( py of long legal descriptian}
<br /> ,� _... _�... _.,.,,, .. �
<br /> CONTACT I�����"��...::. _.....::: �..:�. �..m.�_�::..��...��� � ...��....:_� .. �..�:::.
<br /> OWNER NAME; ' TENANT NAME�I�'Commerci�l�;
<br /> c�wr���t�it��t����r��> �,�� � . ��` ���' _ _
<br /> c�tv ,: , '�"�'�"" sraT� �, ' " zia ��`�
<br /> OWNER PHONE: ; .
<br /> � t''��2 C�� E�!UktN�R EMAIL:
<br /> _ :
<br /> �t�IVTf�AGTt)�NAME
<br /> �C�NTRACTOR ADDRESS: srneer � •� � ,,� , _
<br /> CITY / , STATE �'v�� 21P �3�
<br /> �.i��ttT�AC`,�1`�"?I$PHONE: ��" ' ���P CONTRACTOR EMAIL: . -�;.ry'(�'1���.�r�L:2�.,7�'Z� ; c:z��
<br /> CONTRACTQR UCENSE.�(i�F,������g� �t� f,�"� � .
<br /> •- . . � � � ��QF EVERETT BUSINESS LICENSE�{���iI��17�: ����
<br /> . ,
<br /> PRIMARY CONTACT: ❑OWNER � �
<br /> _ ,
<br /> �YNTRACTOR ❑OTHER(Please 5pecify)
<br /> �ONTACT NAME: � CONTACT PHONE: `
<br /> .�� � � �, �� �: �:
<br /> °` � CONTACT EMAtL: ,.
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<br /> �t�1�.�1��#�'E��'.,�1���„,; - `.
<br /> . _ _ _ _ _ : +���i�.
<br /> Eac�� " Use of Bt����� � Contract Price of Work:� ��
<br /> i��ca �r�Use of Buitdin ; Heat Source: �aas ❑Electric C7Qth�r
<br /> ��►�� � � �R de€a�hecl ❑5FR-Attache ° ' !�c OMuIti-Fami1, =�#of Unif�: ❑Commercial Dlndustrial
<br /> Y p�o�Pro° t w DAddition .I. OSi I���rfnkter ❑Demolition ❑�han e of Use
<br /> . ❑�lai�ir
<br /> C�ES�F�t�Tlb �?Nt�RKs _ , _
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<br /> AS.�(��� "��D BUILDING PERMIT# if a'' �cable:
<br /> ' MECHANt. rPERMIT APPI.ICATItlN Pb,t,�MBIN¢.PERMIT APPLICATiON `
<br /> � _
<br /> Type of Project: _New ` Addn _Alteration `Repalr T --
<br /> #of :
<br /> ype of Pro)ect: _New ,qddn _Alteration `Repair
<br /> Fixtures �ist ot Flxtures #of L/st of Flxtures *°f Ust of Fixtures #Qf Llst of Flxtures
<br /> FlXfures Fixfures Flxtures
<br /> A/C—Air Handfing_Units Heat Pump `ToAet ' `
<br /> Forced Air S stems ackf#o+�Preventer, tns�de B1d )
<br /> Y Unit Heater ��thf�tb ' _ _
<br /> ��S P1 ir�' ' Urinal .
<br /> 'Boiler Lavatory jWash Basin} �����i FourtY�t�a
<br /> ���"������" Refri era#ion Shower Floor€7C�it�
<br /> Gas Fireplace W�od Stove
<br /> Kitchen Sink&Disposat ,�p����°��
<br /> Gas Ran e Ductin ' ' Dishwasher 3���sf Drains
<br /> Ciothes Dryer HookuPs ; Other. �iothes�as"he�` �1�d`t.Ga�Gas
<br /> Ran e Hood ` _
<br /> '.. �lN'BE��Heater _ Othe..r. _
<br /> Exhaust Fan " Sink Service/BaNMo /etc. ���;,, -
<br /> SPR�NKL�R!x$�l�' ... . ;S�ON<�'�'�t� : .
<br /> _...
<br /> trr�-. ,a :ea.s
<br /> aCKNOWLFDGEMENT.•!have reviewed this application and confirm the information contained herein is irue and conect. Wark done pursuant to this permit must comply with
<br /> :ument federai,state,and local law.The granting of a permit only authorizes appraved work and no devlatlons therefrom.Deviations must first be authorized in wr'rting from the
<br /> 3uiiding O�cia!before being authorized under any circumstance.I am ihe owner,or I am aufhorized by fhs nwner of this property fo perform the work for which application is made,
<br /> ind/comp/y with the State Gontractors Law 18.27 RC W and 296.200R WAC.
<br /> �
<br /> City of Evere#t OKcia!Use�pafy
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<br /> � . ,.,a�� ��� ��- � �� �...� �.�c� ��� t� � — O�--`�
<br /> � ra�I�uft�►+�rfz��A�eitt�ign�fut�, � Date �fae�r7s�rc�:�'��J2�t�.
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