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PERMIT APPLICATION
<br /> BUILDING/MECHANICA�/PLUMBING/SIGN /SPRINKLER!DEM(}LITION
<br /> ` - CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8610 � FAX 425-257-6857, ;. everetteps(3�everettwa.gov;� rvww.everettwa��e�aF�.s
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<br /> _ ��� _ � �PROPE... _ . .. . :
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<br /> PROJECT SITE ADDRESS; �,��C•� (p�,�` . ',_ S RTY TAX#: �
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<br /> E.��,1Cf:for new construcNon: Short PlaUsubdivtsfan Lot No.� (attach copy ot long legal description)
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<br /> _ 'CFJNTACT::IN�ORNIAT� 1��:�-��; ��� ,�,���< -
<br /> C4YY'�+i�1"s NAME: � .
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<br /> TENANT_NAN{E"�f�a�i�tarc�
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<br /> OWNER MAILING ADDRESS: . s�eer ` �t�� �'" • � - ,,
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<br /> 4�,At�ti1ER PHONE: _ _ _
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<br /> �t7�+11"�C'�"0�'NAME: _
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<br /> G��i'!''RA#:7'L`�R ADDRESS ,_...,. srREET
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<br /> Ct# f�A�•'1"0R PHONE: - ; ,
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<br /> F��flti+�CON=ACT: ❑OWNER CONTRACTOR �OTHER(Please 5pecify) ,
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<br /> CONTACT NAME:
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<br /> CONTACT EMAIL ; '
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<br /> E���ti" Use of:�7��';;, +C�ntt`a�Price o!Work.�i....: . :. .,' a
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<br /> P�� .asei�;Use of B�ti�t#i� ; t^i�a�Sour.ce ;, � ❑Electric ❑Other
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<br /> �uifdir� '� �; R-�etached ❑5FR-Attached �d�� t��� �Mu� �, -
<br /> IN Fa►ri,'�of Units°, ��amm_ercial, �Indust�ial
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<br /> 'C �of F"tca s�€; ONew DAddition ❑Remodel C�,f'te ir ❑T.I. CIS� ❑� �it��1��' ❑pemolition .OGhat�` ' of Use
<br /> ������'I��1`�"WORK: :: _
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<br /> AS�CSCl;ii1.'fEf]BUI..LDlNG PERMIT# it;a I�C�bie:;,:_ y
<br /> 14�����lC��:°P�R�IT'�lR�t����'�`t��'h ��; a : �;_����8���1�P, ��_ _.��`�!�:1�1"�"l�3�"
<br /> 7�t�r of ProJect: _New ,_ Addn Alteration_Repalr Type of Project: New _Addn Alteration _Repair `
<br /> #of : _ .. . ,.—
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<br /> ?�� Flxttlres �� �
<br /> AlC-Air Hand(in Units Heat��u�n�r - '� '�'�jjl�{ �� � � � ��
<br /> ` � _ B����.�reventer�it.�;Bld �
<br /> Forced Air S stems Nt�t��#�� :' Bathtu.h _ " -
<br /> _ Ur#�i
<br /> Gas:Pipin ;. �i��(er ;Lavato Wash Basin " i7rinkmg Fguntain
<br /> Water Heater' ° - '
<br /> -- e�; �i ' Shower Flo.or Drain, '
<br /> Gas Fire lace , Yt1�+ $tque .,3 : !KCtchen'Sink&Dis osal �rease"F'�a
<br /> _ Gas Ran e _
<br /> Ductit� Dtshwasher
<br /> �: � �2oof Drains
<br /> Clothes D er Hooku s � ��e� C�oth�s`:. a�her . ; ` �led.icaf�as' _
<br /> an e ood ". �er 'eater t)ther:
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<br /> Exha�st Fan ; r� @tvfi��$�C�,.Bt� L���t���:
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<br /> ` S�iNKLER l;';�lJP'P��t�tt#N:.SYSTEM , :::
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<br /> Chemical or Water" : _ , . -
<br /> No,of Heads
<br /> ACKNOWLE�GEMENT.��.haVe reviewed fhls appl/cation and conf/rm!ha informallon conlained herein ls trus and conecf.Work done pursuant lo this permit must comp/y with
<br /> current/ederal,stale,and locst law.The gren(!ng of.;�:permlt only,authoHzes app�oved work and rto devlafions fherefrom.Deviaf/ons must f/rsf be aulhorfzed!n wri[Ing/rom the
<br /> BuildJng Ofpcial6efore being authorized under any Grcumstance.'t am fhe owner,or?Y am aufhorized by fhe ow�er of fhis property to perform tha work tor whlch appUcatlon'ts made,
<br /> and�:compiy wifh Ihe State Contrac�ors taw i8.27 RCW and 296.200A WAC.
<br /> City of Everett O�cial Use Only
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<br /> ��auu��rt�e�� ���►����. � aate ,� .
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