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_ _ _ �...IIIIIIII I� ._ _ . . ...� ,.. __ ._.__._ .
<br /> PERMIT APPLICATION
<br /> BUILDING/ MECHANICAL/PLUMBING 1 SIGN I SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET„EVERETT,WA 98201
<br /> ` _:..:. (P)425 257-8810 � FAX 425-257-8857 l(Ej�aie��ts�e�refku�:g€�� www.everettwa.gov/permits _._
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<br /> �I�,s or Blac�c i�k;�. ;:�'� :` PRC,�ECT$fTE;lN�RMATC�M
<br /> �R#�E�'��3�/kE�Di��$S: ,>, :�. .,;.�,��:. . � .`_ � _
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<br /> G"rAL for new construction: Short PlaUsubdivision , _ Lot No. (attach copy of long legal descriptionj
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<br /> _ CONTAGT IN��RM1►Tlt1N, _,., ,
<br /> UWNER NAME: � �, 4 TENANT NAME If Commercial :
<br /> UWNER MAiI.ING ADDRESS: sTREEr ,Z, c�n G1 Ci'�' •.�
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<br /> CITY • , . ,' STATE ., .. .:. ZIP ,:.
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<br /> ` WNER PHONE: OWNER EMAIL:
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<br /> �ONT CTOR NAME, "
<br /> CONTRqC .R ADD ESS: __ STRE_
<br /> CIN STAT�.,,, ZI?
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<br /> CONTRACTOR NE: CONTRACTOR EMAIL: :
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<br /> GONTRACT R LICE E#( EQUIRED): CITY OF EVERE7T BtJSWESS LICENSE#(REflUIREUjp
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<br /> PE�IMAR1�CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT N ME: , _,_ CONTACT PHONE: ���` � (�`� _
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<br /> �� ' C�`eI� . �ONTACT EMAIL: � �� ._ Ol �.
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<br /> _. .. . BUI.L�11��:PERMfT AI�PIM�ATI�N` _
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<br /> ExiSting Usa of Buildin , Contract Price of WQrk; �s � '
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<br /> �'ro Dsed Use of Huildin : 2ieat Source:, ❑G.as ,..�Electric ❑Other
<br /> �uildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units:. ❑Commerclal �Industdal.
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<br /> T. e of Proect: ❑New ClAddition ❑Remodel �Re air ❑T.L ,_C��i n . �.S rinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> ���,t�! �s �� i
<br /> 9 � �' '�
<br /> ASSOCIATED BUILDING PERMIT# if a licable: , .
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<br /> M�CH�1�11?�rAL P . MIT�1►R�'I.X�TI�N. ' PLt�iM��N���1��"�"��L���i�i�'I�M� " '
<br /> Type of Project: _New � Addn ,�Iteration _Repair Type ofProject: _,New _Addn _Altaration _Repair
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<br /> #o� List of Fixtures #of List of Flxtures #oi tisf of Fixtures`: #°f List of FJxtures
<br /> Flxtures Flxfures . Fixtures Fixtures
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<br /> AIC—Air Handlin Units Heat Pum Toilet �ackflow Preventer lnside Bld
<br /> Forceii Air S,steins Unif Heater Bathtu6 Urinal `
<br /> �a��'i i. : �oiler a�ato' ash"BaSin �rinkin �ountain
<br /> 'i�Vater Heafe� Refri ration �hower Ploor Drain :
<br /> �as Fire lace V11ood Stove �titchen Sink&.Dis,osat,:: frease Tra' .
<br /> Gas:Ran e ' Ductln ' Pishwasher ' . " �. Roof Drains
<br /> Clothes D er Hoaku .s &7fher. `, ,. ,Clothes Washer Medical Gas
<br /> 'Ran e Hood ` Water Heater �ther: _: ;
<br /> �xhaust Fan 5ink 5ervice/Bar/Mo /etc. Othe'r:
<br /> SPRIN��/���"�f�S$IQI+t�YSTEM ':`
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<br /> Chemicai or Water No.of Heads
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<br /> ACKNOWLEOGEMENT:)have�eviewed this appficaBon and confirm the Informatlon contained herein is true end correct.Work do�re pursuant to this pemait must comply wrth
<br /> current iederat,state, bcal faw.The�ranUnp of a permit only authorizes approved work and no deviallons therefrom.Deviations must flrst be authorized/n wiifing from the
<br /> BWldJng Offi'clal befora " . authorized under any circumstance.I am the owner,or I am authodzed by the owner of this property to perform the work for whlch application rs made,
<br /> and I compfy wlth the t ` kMIlQ��Law 18.27 RCW and 286.200A WAC.
<br /> ,�y of Everett Offfda/Use Only
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