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BUILDfNG / MECHANICAL,�pMIT APPLICATlUN
<br /> UMBING/SIGN !SPRINKLER i DEMOLfTION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT WA 96201
<br /> (P)425-257-8610 ( FAX 425-257-8857 �(E�g�����,�g����������� �,M,.evereflwa.gov/perm.l#s
<br /> �����e�C Btaaci�tr11c i'3�l�y t��±��r�s+�� ��taci��� =�s',��� � :
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<br /> P1�Q;JECT S�?'E ADDRESS: � � p '� " '
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<br /> � r L• � . PROPERTY TAX#: `:
<br /> LEGAL for new constn�cfion: Short PlaUsubdfvislon -
<br /> _ � ,;�,,,Gdi:No. (attach copy of long Iegal descrlpUonj
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<br /> OWNER NAM�: � . _.
<br /> ; TEMANT NAME�If GommerciaC�s
<br /> QUYiVER MAILING AQDRESS: srR�er ��� v�?'�`J"�1 p�..
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<br /> � .... STA'fB, ��"���^°^
<br /> OWNER PHONE: "�' ,
<br /> ' !OWNER EMAIL;'
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<br /> �QCs1�GTt�R NAME: _.
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<br /> CONTRA�TO,R ADDRESS: L.t�' :_ _ : __
<br /> STREET , • � . � � ���� ��- �� �
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<br /> . . . .. _ ... CRY ; �' , , . .. �.. _ . , ..
<br /> .. , . .,. _ . . ST0.TE` ZIP ���}I
<br /> COM7RACTOR PHONE: .� r
<br /> � - D CONTRACTOR EMA1L: _� �� i.,
<br /> CONTRACT�R LICENSE#���9tItR��i•: ���`'��''�'ti�'" '°�1�"'1
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<br /> �� ����'`���`��Zd n CITY OF EVERE"fT$USINESS LICENSE#��RfQUIRED): ��;¢(��
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<br /> Pi�tMARY CONTAC7: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) -
<br /> CONTACT NAME: , _
<br /> CONTACT PHONE: �' ��C� ��
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<br /> , CONTACT EMAIL; , �„� �+���� '�rn
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<br /> �x�stir��Use of���tdin �; Contract Prlce of Work:S ���'�,�r%�
<br /> Pr�se�i Use of Builditt :,
<br /> Fteat 5ourcen �� C7Electrlc ❑Other
<br /> ��a���� � �: ' �R-Defached ���f�<j�{����� {����9X ❑Mu#tt;,F�m11 ,�p�Units; �Commercla! Olndustrfai
<br /> T �:of�ta�J�ct: ❑New L�Addition ORemodel �� �I� ❑LI. ❑5' �; ❑S rint�6�r ❑.Demo(ftl.on ❑
<br /> t��sGRIPTION OF WORK; - �t� :of Use
<br /> 1 r►S-�,LI ��s � .r �
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<br /> ASSOCIATED BUILDING PERMIT# it�t; Ilcatils t'.
<br /> 141��°��A�iIN�* ��.. ���1V4���`��'�1��1�`� . ,. I�1���,��+6��+! '�"�1�"�at� �.I�t� _
<br /> 1"yp�of Project• ,_New ,_ Addn �Alteration �Repalr T
<br /> #of ype of ProJect: _New . Addn ^Alteratlon ,Repair
<br /> _
<br /> Ust otFlxtures #�� #of
<br /> Flxwres_ Llst oi Flx�ures #of Llat of Flxtures
<br /> Flxtures Flxtures L�gf of Flxtures
<br /> AlC—Air Handlin Units - FJxtures
<br /> Heaf,Pump 7'�#��t ���kflcr�v Preuent�r }iisltia Bfc3` ,
<br /> ` Farced Air Systems Unit Heater Bathtub
<br /> ��s Pipin ��,f��r t�tinal
<br /> water Heater Lavaiory ash Basin Dtinki �auntain
<br /> Refrf eration Sf�ower :' ��,����€�
<br /> ���'����� ViJood Stova" 1Citchen Sirik&Dis Qsai
<br /> Gas Ran e II�eF�n �r�sa�e Tra :
<br /> Clathes dr er Naoku s : i�sh�taS:Fier �c�of�ns
<br /> Other: Clothes Washer
<br /> Ran e Hood ' Medicsf t��s '
<br /> E�°saust Fan _ _ UUater Heater Other: '
<br /> ;51nk(Se(vloe%6ar/MQ letc: Other.
<br /> �e�l'��1+�!'[t.�����`�+�!.,,�5����M'��. , ���1?I �
<br /> Chemical or 1Nater No.of Heads
<br /> ACKNOWCEDGEMENT;/have raviawad thls appl;catlon end contirm�he lnlormaNan con�alned hereln!s lrue end correcf.��.done pursuent�o fhis permlf mus�compty wllh
<br /> curngnt federal,state,and local law.7he granling ot a permi!only aulhoNzes approveB work and no devlattons lherefrom.Devlaftons muaf Rrsf be authorized!n wrding hom the
<br /> Bu1lding O�cJal before being authorized under any clrcums(ance.I am Ihe owner,or I am aulhoNzed by the owner of fhls property!o peNorm the work/or whlch eppNcatlon is made,
<br /> and!comply wlfh(he S7ate Conlractors Law!8,27 RCW and 296.200A WAC.
<br /> �ty of�verelt O�Gial Use q�t/y
<br /> ,. *. PERM1AI /:
<br /> 'Qwae laufhtlYtx�sd{tgsr� ignature ���' �� � � � `-�� �
<br /> Dale �Rev�c!`,. 2��6;�
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