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<br /> P�RMIT APPLtCATlON
<br /> BUILD[NG 1 MECHANICAL 1 PLEIMBlNG/SIGN 1 SPRtNKLER/DEMOLITION
<br /> CSTY QF EVEftETT PERMtT SEIiVICES t
<br /> 3200 C�E}AR S7REET,�VERETT,WA 9828'[
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps(�everettHra.gov� www.erre�etiwa.govlpermits
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<br /> LEGAL for new construction: Sho divis�on Lot No. (attach copy of long legal description)
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<br /> OWNER NANfE:�/�y��� �/ j-�M LLC— 7ENANT NAME(If Commercial): 'l�fyt
<br /> OWNER MAILING ADDRESS: s�eer ZQ�f ��.f �qQ•,/' �U�
<br /> CITY �t '�.� STATE W G�ti ZfP ��Z.E%�
<br /> OWNER PHONE: l-fZ�-4�`7�- 3'`(3? �WNER EMAIL:�rau:�•rt�o�c. . ���.c�v�-�
<br /> CON71iACTOR NAkVl�: s' e�.T�vt
<br /> COfSTRACT012ADDf2ESS: s-rReEr �Q ��/ "�j"
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<br /> CONTRACTdR PHOME: —�O «- �`� CONTRACTOR EMAiL: a'�(��,� �SM Tt .0 Di�t+�
<br /> CONTRACTOR LICENS��(REQU[RED}: � (�( CI7Y OF EVERETT BUSINESS LICEtd5E#(F2EQUIREDj:
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<br /> PRIMARY GONTAGT: ❑OWNER CpNTRACTOR O OTHER{Piease Specify)
<br /> CONTACT NA[N�: CON7AC7 PtiONE: Z�"" 3 p �.�'�(7 7 ' I
<br /> �U�,I�'(,�,�� F r CONTAC7 ENIAIL:'�-01�1CT�►tcw►�QF'6 '7'tit . C d
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<br /> Exis6n Use af Buildin : ContracE Price of Work:$ 2-���
<br /> Proposed Use of Building: Heat Source: as ❑Electric CiOEher
<br /> Buifdin T pe: ❑SFR-Detached C35�R Aftached C1Du tex OMulti-Famil -#of Urtits: �CommerciaE 0[ndustriai •
<br /> T e of Pro�ecE: CINew C7Addition ORerrrodel Ra air C]T.I. E�Si n C7Sprtnkler �Demolftion [7Chan of Use
<br /> DESCRIPTIbN QF WORK: e �g�,� � ,�L�t� yy.y� ' 1 '�� �r �`
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<br /> ASSpCIATED BUILDING PERMIT# if a licable: �':�i"� Ci'�G����
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<br /> ''•':;•::�MECHANI.CAL:<.P..�RMIT<APP,1:..I.C�►TION�;:: ..,. >:. ..._, :: •..;�'RLUMBING�:�+�RM['i;:'APP...L[.CATION�',
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<br /> 7ype of Projeet ,,,„,,,�IVew_ Addh AlteraHon_Ftepair Type of ProjecL• _New ,_,_,_Addn Alteration _„_Repalr
<br /> FlxBrres �+st of Fixtures ��Ur s Lisf of�xfures F�eS Llsi ofFlxtures �fxtu es List of Fixtures
<br /> AiC—Air Mandling Units Heat Purnp Taiiet 8ack@ow Prevenfer lnside B[dg)
<br /> Forced Air stems Unit Heater Bafhtub Urina{
<br /> 4 Gas Piping Bo11er Lavato Wash Basin Ddnking Faunfain
<br /> Water Meater Refrl eratlon Shower Floor Drain
<br /> Gas Fire iace Wood Stove Kifchen SInk&Disposai Grease Trap
<br /> Gas Ftange '7 Buctir�g Dishwasher RooPDrains
<br /> Cfothes Dryer Hookaps Other: Clathes Washer Medica!Gas
<br /> Range Hood Water Heater Otl�ec
<br /> Exhaust Far� SlnEc(SsrvicelBadMoplefe. Ofher.
<br /> `��'-- ;SPR��11Ci�ER����3�PPItES$(„Oji1;�SY�T�lltl:=5� �'�;�;
<br /> Chemicaf or Water No.of Neads
<br /> ACKNOW�EDGEMENT.•I have revlawed thls applfcation and conflrm the Information contatned hereln is bus and correct.Waic done pursuanf to thls permlt must eamply with
<br /> current faderal,state,and locatlaw.The granfing of a perm$oRly aufhorizes approved wark and no devlations fherefrom.aeviat7ons mtutllrst be authorized irt writing from the
<br /> 8u!lding qlliciaJ before keing artthorrced under eny eircumstanca.l am fhe owner,o�(am authorized by 1he owner of thls properfy to per(orm the work lor whleh appflca[hn!s made,
<br /> and 1 cor»pJy wifh the State Coetractors Law 18.27 RCW and 29s 200A WAC.
<br /> fr Cfty of Evereft OHkla!Use On/y
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<br /> ��iN'mef/Authorized AgenY Signature Date (Ravised 3/232098)
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