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PER�i'i(1'�PPI.ICAY90�1
<br /> �t11LDING J��CH�4NIC.AL./�'Lt9Yl��6�l�I S(GN 1��9�14i9��,�R 1 DEfl1IOLlYION �
<br /> C1TY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98209
<br /> (P}�25-257-8810 � FAX 425-257-8857 �(E)everefteps@evereifwa.gov� www.everettwa.gov/permifs .
<br /> (�►cae or�[ack 1t�1e�.�Iy.�lease) . . I������I'��`��IC�I���fV11,R1`YI�W .' . ' . � . .
<br /> PROJECT SITE ADDRESS:.��I�— S PROPERTY TAX#: P����- DO�O�Of�(�
<br /> LECAL for new consfruction: Shorf Plaf/subdivision Lof No. (attach copy of long Iegal description)
<br /> . . _ . . .. . • ,��W'TA�`Y IRd�'�RIM1f��'�I�E1 • - � . . � .. . . . . . .
<br /> OWIdER MAME; e �-t'-�([�t'S-�� TEIVANT NAME(If Gommerciai):
<br /> OWNER MAILIfVG ADDRESS: STREET �� ����"!�/ S� .
<br /> cirr � srn� V Y ztP "C p�i'V,3
<br /> OWNEl2 PHOIdE: ��5�--3�—k-�—'a-OQ�Q OWIVER EMAIL:
<br /> CONTRACTORNAME,, ..C.,••n.�-••••,..��-�� ..�^`�F/�-TCo�T �?$'E��W��r�- -
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<br /> GON7RACTOR ADDRESS: STREET °yI`�i'U ��� �(J�
<br /> IlY �+U6'syc�� STATE (�/f� ZIP ���
<br /> GONTRACTOR PHONE: �2 j.�t�2>�j(J . CQNTRACTOR EMAIl.: l�SI(e �5��"j�JI�G� ,
<br /> CONTRACTOR LICENSE#(REQUIRED): �(Jg���(y�'j���,�� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C,6 �'j' •
<br /> � ,. .. . �..,�. ., ... .. .... ,..,��_._...._,_.w.......,,................_...,:,..,...__.,�,,..,.,M..,_.....,.._...,.,..._,......._.._,�,.,,.,........:.:..,.,.--,-�..,.�.,...,_...,,.,,.,.
<br /> PRIMARY CONTACT: 0 OWNER I�.CONTRACTOR ❑OTHER(Please Specify)
<br /> COPITACT MAME: COMTACT PHONE; l#�cj''d��ry s���(�
<br /> �l I-C l.�' (� YYI�/1 CONTACT EMAIL: l� ��„� ��(N�' e��
<br /> . . . . ' � . . � . .. `" BIJII.DIN(�PERlVlIT APPLIGA`i'►0N " � . . . . , . . . � � ..
<br /> Existing Use of Building: S� �� �( � Confract Price of Work:$ �
<br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Ofher
<br /> Building Type: FR-Defached CISFR-Affached ❑Duplex ❑Multi-Famify�#of Units: ❑Commercial I�lndustrial
<br /> Type of Project: ❑IVew L7Addition L7Remodel ❑Repair ❑T.1. ❑Sign �Sprinkler ❑Demolifion ❑Change of Use
<br /> DESCRIPTfON OF WORK:
<br /> r�la�. Pr�ciS�in�r o�.s-�vc�-na �- , �
<br /> ASSOCIATED BUILDI�lG PERMIT#(if applicabfe):
<br /> • ' .M�CI�ARI(CA[..P��PIiII�'Ak��I IC�`i'IOM � • �L,�lM�Ifd� P�F�IViI`���P�I�A i"10[d : .
<br /> Type of Projecf: _Atew Addn Aiferafion _Repair Type of Projecf: _,Plew Addn A►ferafion _Repair
<br /> �°f List of Fixtures ��f List of Fixtures `�°f List of Fixtures �°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Unifs Heat Pump Toilef Backflow Prevenfer(Inside Bldg)
<br /> Forced Air Sysfems Unit Heafer Bafhfub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Founfain
<br /> Wafer Heater Refrigeration Shower Ftoor Drain
<br /> Gas Firep(ace Wood Stove Kifchen Sink&Disposal Grease Trap
<br /> Gas Range Ducfing Dishwasher Roof Drains
<br /> Clofhes Dryer Hookups Ofher: C.lofhes Washer Medicaf Gas '
<br /> Range Hood Wafer Heafer Ofher:
<br /> Exhausf Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> .'�I�,RIt+9FK�,�I�/�U��I����Q�L�9��FSY�YVi
<br /> .... . . . . ... .. ...
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•I have revrewed thls applicatton and confirm tha information confained herein is tr�e and correcf.Work done pursuant to this permit must comply with
<br /> current federal,state,and local law.The grantrng of a permit only authorizes approved work and no deviations therefrom.Deviations musf first be aufhorized in wrifing f�om the
<br /> Bui/ding Officia!before being authorized ander any circumsfance.1 am the owner,or!am authorized by the owner of this propetfy to perform the work for which application is made,
<br /> and i compiy with the State Contracfors Law 98.27 RCW and 296.2o0A WAC.
<br /> City ofEvereft Official Use Only
<br /> � f/� /I � PERMIT# � �
<br /> � •
<br /> ner/Auffiorized Agenf Si afare Date (Revised 5/20/209fi)
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