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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL t PLUMBING/SIGN /SPRiNKLER/DEMOLIT!()N
<br /> CITY OF EVERETT PERMI7 SERVICES
<br /> 32Q0 CEDAR STREET,EVERETT,WA 98201
<br /> ` : (P}425-257-8810 � FAX 425-257-8857 �(E)everettepsQeverettwa.gov( www,Bv�i'�t�:�t�(ssttnits
<br /> �ic���rr�i��i�itc.t� . ���a�t� , ;:PROJECT�'������. It�N . :,,, � f",� : �� `�.,
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<br /> �ROJECT SI7E ADDRESS: ' .`� � �"y� �°� pROPERTY TAX#:
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<br /> #»����.for new construction: Short P�atJsubdiv(sion Lot No.� (attach copy of long legal description}
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<br /> QW1d�NAME. �"Q� TEN/�NT N.AME(i�Goerte���°a�i�
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<br /> d�Cd�R MAILING ADDRESS: s�EET: -;
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<br /> OWNER PHONE: ��'��7 ' . �7`4YN�l�;EMAI4«:::::: _. ;
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<br /> CONTRACTOR NAME; .', ::. , :;�,� _
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<br /> CONTRACTORADDRESS: STREET �� . �
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<br /> �ONTRACTOR PHONE; � :.��, �{� �ONTRACTOR E�i���, ,-_�,. <� . ; ,� ,,�
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<br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑OTHER(Please Specify)
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<br /> �t�'!�T NAME: ��'ACT PHONE: #�.�Gry �SC� ��
<br /> ��`'rq'�'' CONTACT EMAIL �
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<br /> �rastEn- Use of BuiRdi� ; Gontract Price of Work::;�_ ��.�. " a
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<br /> , Pra psec�Use of�srtkiir�', Heat Soures: . ��s DElectric ❑Other
<br /> ' ��i(ct1�e' T '�: ' �R•R��h� ❑SFR-Attached OL� 18�C-. ❑Mt��E���1Tiit �'t��tl�k�. �Commerclal ❑Industrial
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<br /> �of,l� ; ONew_ �Addikion ❑Remodel Q(Ze""r pT,�„, �}�r �t [�� 't� ❑Demolition C]Chats �ofUse
<br /> ; pESCRIPTION,.i�3�iA�}�"�;,�' �� : �
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<br /> SQ:CIATED._BUILQI...N..G PERMIT# -a'; I�G�f�it�:;;,. ;
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<br /> ; ,-MECHANt :#.�PERMIT.�M���.�Gl�,',�''tID�+�.=
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<br /> .y�of ProJecG'_New `_ Addn `Alterallon _Repelr Type of Project: _New _/�1ddn _Alteretton"iRepalr
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<br /> #of #of , ..., _ _ _
<br /> _ _. � � � ;, � " x�!ges� ;:.. . ,, ,. Rxtures �..ue�,,,,'
<br /> A/C—Air Handlin Units �:P�r�� , ` . ' ' Toilet Backflow Preventer Inside BId
<br /> Fo�ced Air S stems Unif 3�eater� ' �athtub;:: _ Urinal
<br /> �as Pipin _ _ �dt�t _ L�vato ' 3sh Basin �}rinkin ountain
<br /> W�tec H�ater ` _
<br /> . _ . �±4i'a. 'Shower loot Qrair►
<br /> Gas Fire lace "' �d,Stove Kitchen Sink Dis osal �rease Tra ' ° '
<br /> ;Gas F2an e #�,r " _.;Qishwa§her �toof Drains_
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<br /> : Clothes D er Hookwps 2', �`j��; ° ;Cfotties"INasher° Medical Gas
<br /> ' an e Hoad : _ : 'Water Heater fher. - `
<br /> Exha�st Fan ` ` Sink Service/Bar/Mo /eta �7the�: --
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<br /> ` ;SP�tIt��1���Ei 7;SUPPRESSION$Y;��4! _
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<br /> Chemical or Water ;.; '::: _. ;
<br /> No._4f Heads
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<br /> ACXNOWLEDGEMENT.•p'have rev;ewed(hls application and confirm the lntormetlon contained herein ls true and correct.Work done pursuent fo thts permll must compty with
<br /> current federal,state,and local law.The granUng ot a permlf only authorizes approved work and no deviaflons therefrom.Devlaflons mus!f1�s16e authorized in wdttng irom!he
<br /> Buftding O�da/before 6eMg authorized under any circumsta�ce.;l am fhe owner,or;�am authodzed by the owner of fhfs property to pedorm(he work ior whlch applkatlon:ts made,
<br /> and�comply wifh fhe State Contractors Law�8.27 RCW and 296.200A WqC.
<br /> City of Evereft Otficiai Use Only
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