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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL t PLUMBiNG I SIGN/SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
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<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> ` _(P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits
<br /> �tue or Black Ink Qt�� ���e) ��tO.�ECT S1TE INFORMATION
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<br /> PROJECT SlTEADDi?ESS: �QI D , �MI.� �t:_ �!r . T/N PROPERTY TAX#
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<br /> LEGAL(or now construction: Short fN�t��adlv���„_ 'L�No. (attaCh copy.of fong legal description)
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<br /> GQNT.ACT lNFORMATION .
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<br /> OWNER NAMC-� _ ;; j,;�r'Q TENANT NAME�If CommercF�t� _
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<br /> OWNER MAIUNG ADDRESS: STREET ', ' �O '
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<br /> OWNER PH�NE. �,�Q •-' l.�.•� " OWNER EMAIL:
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<br /> CONTRACTOR NAME: �, . .� . � ,.. . ,
<br /> CONTRACTQR AQDR�3S:.._.. STREET , , - `' �
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<br /> CITY� ..�.�. .• :.� '" ;'�� _...��. , S7ATE,i• ` . -:. _._. �.,_. _._. ZIP.��. , , � " -� :
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<br /> �{3j�1TRACTOR PHONE: . . , ,- �e�` � ;G4?{VTR,�'E'#:iR.�M�L.:' :�� ' �,.
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<br /> ��}°CRACTQR LICENS.E��1��t2j . � „ � :' ;. ,. CITY OF EVERETT BUSINESS LICENSE Y#��E�Q�tk�D)a � ���
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<br /> P�#MARY CONTACT: ❑OWNER ; " CONTRACTOR ❑OTHER(Please Specify). _
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<br /> CONTACT NAME. CONTACT PHON� '. ��, -
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<br /> CONTACT��Ai ;: r
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<br /> � �__ `` � ���' �gU1�LDINGPERMIT APPLICA710N� �
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<br /> �isti�"Use of BuT�tln ;. Gontract Price of Wock:$ ' _ �. ' ;
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<br /> �?�'c�s;ei�Use of f3uildi�':- tleat Source as ❑Electric OOther
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<br /> ��ZCdatt i' p�: ,. SFR-Detached �S.FR-AttaChsd ,�Qu ��- ❑Multi-�� :- ofUniks; �Commercial, ,,�Industrial
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<br /> �' ;of!� ��t�: L7New OAddition_ , �Rempdel_ � r DT.I. O$� 5. C]S �i`E�t�'� ❑Demolition ���� �z of Use
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<br /> bESCRIP710N OF WORK:
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<br /> �4�^�OCIRTED BUILDING:.P...ERMIT#_if� ��b , _ _
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<br /> MECH�►NICAL PERMIT APPLICATIdN . �� PLUMBING`�ERMIT APPLICATION
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<br /> 'fype of ProJect: _New _„ Addh _Altera4ion _Repalr ;:, Type of Project: _New ____Addn _Alteration _Repair
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<br /> Fixtu�es ��st of F�xtures ;:,Fixtures Llst of F/xtures ;Fixtures! Ust of Fixtures ;Fixtures :; List of Fixtures
<br /> NC—Air Handlin UnRs Heat Pumg ;Toilet 8ackf(ow Preventer([nsid��ldgj
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<br /> Forced Ai�Sy.stems ' , Unif Heater.`; .... ._ . : ',Bath#ub' , �Jcinal ' ;
<br /> �as,Piping ,
<br /> Soiter ,.,Lavato: , Wash'�asin` __ �rinkin Fountain
<br /> Water Neate.r Refrigeration Shower Floor Drain
<br /> Gas Fireplace VI/ood Stove } �C���is:. �k&.:'�.. ..4,,, Grease Tra_;
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<br /> ; Gas;Rar� e : C3UCttn , - _ :: [��&hWaSh@I� ,. ; Rooi Drams::' `
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<br /> ` Clotfi:es t? et'Hoofcu :s' ` �tfier. " '
<br /> _. 'Clothes Washer _ Medical Gas
<br /> �2an e Hood' 'Wate�Heater �ther. '
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<br /> Exhaust�an . , _ Sink .5.eruicel�arlNio,/efo:� ;: Other: ,
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<br /> SPRINKLER7 SUPPRESSiON SYSTENI '
<br /> Chemical or Water No.of Heads ' _
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<br /> ACKNOWLEDGEMENT:!have reviewed fh/s applicatlon and coniirm the information confained herein is frua and correct Work done pursuant to this permrt must comply with
<br /> current fedaral,slttle,and loca!law.7he granUng of a permit only authorizes approved work and no daviations there/rom.Aeviations must frrst be authoiizod in writing trom tho
<br /> Building OHicial be(ore being aufhorized under eny circumstance.I am the awner,os I am aulhodzed by the owner of this property!o perform lt�e work lor which application is mado,
<br /> and!comply wifh the Slate Confraclors Law 18.27 RCW and 298.200A WAC.
<br /> Cily of Evo(e4t Oflicial Use G��T�^„
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<br /> , �•��' t 7 PE ,.,� .1.��� � \��
<br /> t3wrta�! u#�tw�ized Agent'S ,-: ` ,; Date _' , �+1,� 9IZ3f20'1Bj __
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