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PERMIT APPLICATION
<br /> BUILDING/ MECHANICAL/PLUMBING/SIGN !SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREE7,EVERETT,WA 98201
<br /> {P)425-257-8810 � FAX 425-257-8857 �.{�}everetteps@everettwagov� www.everettwa.gov/permits
<br /> (E�lu�or 5����:ink Q�t :P1��+� p ��`�!��'N'�,���� . ."�'1: _.
<br /> PROJECT SITE ADDRESS: � ' � .� �„ �� PROPERTY TAX#:
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<br /> L.E#a��for new construction: Short Piat/subdrofs�a�t. #�t�I No. {attach copy of long legal descriplion)
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<br /> t7VYNER NAME: �, ( , . ., TENANT NAME{:If`Com�r�r�i��,> _ _
<br /> C%V91I+M�R MAILING ADDRESS: sreeEr , 1�-Q- _ _
<br /> ::, „ .. CIN ��y�«�w�^� . STATE.:� � � ,._.. ZIP . .
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<br /> OWNER PHONE: ,� � ' ,. _
<br /> t�1+lthi��t EMAIL:
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<br /> �+pt�'CEiA�'t'i1R NAME; '
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<br /> GO�f.TRACTOR ADDRESS: sraeer _
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<br /> . .. CRY .. � :, � ... �,. ..... STATE��� ZIP
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<br /> �t?�(Tf���'��f�PHONE: .
<br /> #� CONTFtACTOR EMAIL: . ' �
<br /> �y �+ � � i; "C'�"#"1�'`��'�� &�
<br /> ���5(.TfkA�1`t��UCEIVSE i�(R�CC�t!(����;��h'�t, =`�-i7��IC�Y"� C['F°Y`OF EVERETT BUSINES5 UCENSE�(�t�l1��C�C�}: �LA"��..
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<br /> PRIMARY CONTACT: ❑p1/�/�j�R �CONTRACTOR L�OTHER{Please Specify)
<br /> CONTACT NAME: � G�?�ACT PHONEi
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<br /> . ���I'T'ACT EMAILc ,. ��'P. , t'�Vlitt�'i� •�0 M
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<br /> : �IJl�„1�1t�"�'.���'1" , ::�,I� x�. �!i
<br /> �xisttrt Use of Eic�{I�iln .: : . ;.
<br /> _ �r��stl��t Price of Work:'� �'�'.�
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<br /> ��pp���d Use of Bur��i ". Heat Source: ❑Gas ❑Electric C�G7t�i€��
<br /> ��1�6T., fi c�. ` �R-Detached ❑SFR-Attached ��tu i�� ❑►v��#�.���� ' of U�its� ❑Commercial ❑Industriai
<br /> '�,'" of Pr�+°ect: ❑New �Addikion �Remodel apair ❑T.1. ��� ' ':�� r�nkler ❑Demolition ❑C�t��tg.e. of Use
<br /> EJESGRIPTIf31S1 OF WORK: .,
<br /> �eeQ t c2.c.� a,�s -�vr�.Q,c�„
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<br /> �tS�Ct�},p�T�D B,UfLDING PERMIT# fF�; tir,�bi�::
<br /> fitl�G�fAI'�1��1L�;.P,��lMU'�t'�'�P�'�1#`���"�l�tl�i, " ;�L,Ul��,M�E3���1��1�'�'°i�'#����Tii?N
<br /> ,Type of ProJect: ,�New " Addn _Alteratlon _Repalr Type of Project: _New `_Addn ,_Akeratlon _Repair
<br /> #o/ List of Flxtures #of ,' . #ot #of
<br /> Flxtures Ftxtures Ust of F/xtures L(st oi F/xtures Llst of Flxtures
<br /> Flxfures Flxtuies
<br /> �4lC-Air Handiin Units Heat Purnp 7oilet �acktlow Preventer lnside Bid
<br /> Forced Air Systems Unit Heater "' Ba#htub ; Urinal - -
<br /> ' Gas Piping Boiler Lavatory,.Wash 8asin) prinking Fountain
<br /> Water Heater Refrlgeration Shower" ` Flooc Qrain
<br /> Gas Fireplace ood Stove Kitchen.Sink&Dis osal ` Grease 7rap
<br /> Gas Ran e Ductin " Dishwasher Roof Drains "
<br /> Clothes Drysr Hqakups Other: Glathes 1M1/�sher' '' Medical Gas
<br /> Ran e Hood
<br /> _ Water Heafer C7the�: ;
<br /> Exhaust Fan "' Sink ServlceBar/Mo /etc.' C7ther: ` °
<br /> SPRiNKi.ER 1��PE����lON�`xl���'�� . ` _ _
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<br /> Chemical or Water No.of Heads
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<br /> ACKNOWLEDGEMENT.•!have revtewed thls app(ication and conflrm the iniormation conlained herein Is true and correct.1Nork dane pursuanl to(his permit must comply with
<br /> current lederal,state,and locai taw.The g�anflnq of a permit on/y authoHzes app�oved work and no devla(ions lheiefrom.L?evlatlons must Arst be authorfzed in wriUng from the
<br /> 6uildfng O�claf before being aufhor/zed under any circumsfance.1 am the owner,or!am authoNzed by Ihe owner of thts property to perform[he wark for which appNcafton is made,
<br /> and I compty wilh lhe Stafe Contractors Law 18.27 RCW and 298.200A WAC.
<br /> Cily of�veren O/ficia!Use Only._ ,.
<br /> >. PERMIi,�
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<br /> '�u�rrs t�a�il��x�xed Agerr Ig�n�care ' bate . .
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