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08/03/2016 wED 10: 30 FAx 425 252 1666 CM aeating �pp2/p02
<br /> PERMIT APPL.ICATlO
<br /> BUILDIN�CHANICAL I PLUMBING /51GN�RINKLER/ DEMOLf710N
<br /> ClTY OF EVER�TT PERMIT S�RVICES
<br /> 3200 CEDAR STREET,�V�RETT,WA B82D1
<br /> (P)425-257-Ei8'10 � FAX 425-267-985T �(E)everettapa(�everettwe�gov� evww.everatiwa,gov/permlts
<br /> �1�� ' 1'. �t4kr� .i��` f�4���F�r ' � Q. ��T$I�'� 1� �R, I.1T1.8 �
<br /> PROJECT SITE ADDRESS: j PRQP��i7Y TAX�t;
<br /> LEGAL for naw Constructlon: Short Plat/aubdlvlelon Lot No. (attach aopy 0�long legal deacription)
<br /> � , � . � , .,`: • , . , CbM1.T� '�'11�P¢RMATIp[il
<br /> OWNER NAM�; � TENANT•NAME If Commerclal):
<br /> OWNER MAl1.INCi ADDRESS; BtkEET r � �� �
<br /> CIiY 5TAT6 ZIP
<br /> OWNER PHON�; QWNBR EMAIL:
<br /> CONTRACTOR NAME;
<br /> CONTEZACTOR ADDR�SS: BTREET
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<br /> • ciTr srnre zu�
<br /> CONTRACTOR PHONE; � CONTIeACTOa�MAIL: �jm
<br /> CONTRACTOR LICEN3E#(REquIR�l�) ���� CITY OF EVERE7T BUSINE8$LICENSE#(RE�UIR ):
<br /> PRIMARY CONTAaT: ❑OWN�R ON7RACTOR I,�07N�R(Pleqse$peclfy) •
<br /> CONTACT NI1M�: CONTACT PHONE: "
<br /> � ' "�'� � CONTACT EMAIL: ��
<br /> , �;'i;�; ;;��'jyt ,��F ..+nyu;. • , , '.S.i� yc!„ . , . , . .
<br /> Exlstln Use of Bulldln : Contr�ct Prlce oi Work:3
<br /> Pro o�ed Uae of Bulldln ; Heat 3ource: Gee ❑E ctrl DOther
<br /> Bulldln T e: QSFR-pet�ched �3�R_Attached C7Du lox ❑Multf•Famll -#of UnItB: ❑Commercial C�Industrlal
<br /> T e of Pro ect: ❑Nsw C1Addlt{oii Qit�mo�el ❑Re air �T.I. ❑SI n OS r{�kler ❑Demolitlon ❑Chan e oi Usa
<br /> DE6C IPTION�F WQRK; �
<br /> �U.� �1►�' C�s U�e rro ���+ ,�i;,�e �n� �s �� b�_�,.,a�, �n �a�s� �:�
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<br /> ASSOCIAT�D BUILDI��RMIT# If H Ilvebl• ;
<br /> ,� �� .�P i. � ,'�;'.',:,"i%�d' '�',�1"�,?,,.r„ cp�. :,r .�.� 1
<br /> � � � � � � � ���-�� ���'�� . � -� �n:�r�:.
<br /> Typa of PraJeat: r,Pl�w _ Adtln `�P►Ite�pt1011 _R�p�,lr Typa Ot ProJ6Ct: _Naw �ddn WA[tsratlon ,R6palY
<br /> #ot �t8t of�Ixtur�s Q ��� il of
<br /> Fi uraa P/xlpros tlat at Flrf++rea L/st o�Flxturas �,ldt o/Flxtures
<br /> Flxturos �lxtuna
<br /> � C—Alr Handlln Un ta Neat Pump Toflat Baokflow Prevent�r Inside Bld
<br /> Forced r S 5tems n t e�al�r st i u Urinel
<br /> Gss P( In o er� � '� l,avato ash es n rinkln Fountain
<br /> Water Heafer e rl �retlan hower Floor prain
<br /> Gae Plre lace ood S ove Kltchen 5 nk&pis osal Greese Tra
<br /> Gas Ran e buctfn D ehWasher Roof Dralne
<br /> Clothes�P er Hooku s , Othe�: C othea Waaher Medlc�l Gas
<br /> Ran e Flood Water Fieefer
<br /> Other:
<br /> Exhaust Fan 51nk Servlce/Bar/Mq /etc. Other:
<br /> "��Y�� �2 � .l �f�iFy5��4�f� .
<br /> um er o ea �
<br /> ACknfOWL�DO�MENT•I havo revtewad!h!a applloatlon a��f CoMlmr tbs fn/ormatlon cont�/ned haroln!�true end car.ect Wo�k dane Aursuanf to ihls permlt must oomply w;rh
<br /> current federel,atata,e�ad focellew. The aranfing o/e permlf only eulhorizos approved work and na UAvl�tlona thererrn.r�,Devlatlona mvet//rat be eulhor/sed In wyflnp�rom the
<br /> 6ullding ON/c%1 balare CBing�Utf�oNaed und6r 9r1y c%r�umstsnte,f em the ownar,or I am aUlhoNzed by the owner of thla property fo peNarm iha wark far wn�ch applleetlon 1s made, �
<br /> and f compry wlth the 5iato Contreofnra l.aw i9,27 RCW end�g@,200A Wi4C.
<br /> air aE�e�a o�c�ai uso onry
<br /> . � � � � PE IT 1 OO o � ��
<br /> OwnarlAuthorizod Aga�tt 9lpnature Oate (Revfsed F/20/2018J
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