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PERMIT APPLICATION
<br /> ' ' BUII.DING/MECHANICAL i PLUMBING/SIGN /SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVtCES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> {P�425.-257 681:Q � FAX 425 257 8857 I�EI���i#��g�est�Fe�t4v��W� www�Y��t,g�r/�t�its
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<br /> ��ECT SITE ADDR...ESS: : „+�,," ' .;�. ; :; � ; _ _ _ PROPERTY TAX#: _
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<br /> ��for new constructton: Short�u�sdlv%Ist�rt, Lp"!No.° (attach copy of long legal descriptlon)
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<br /> OWNER NANtE: � '' ��" TENANT..N...AME If,Comm�tci�f}:; _
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<br /> ' Q��tPER MAILING AdDRESS: srne�T � ' ' � '
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<br /> C7WN�E�PHONE: Z '�J '. ,.� OWNER EMAIL:,
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<br /> I G�k�'RACTOR NAME,. -
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<br /> ! ��iTRAGTOR ADDRESS: srn��r �_ -. ; ���� •
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<br /> +�N���'�;PHONE: �� � CONTRACT.OR EMA1L . , , ,`�. �,� .
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<br /> PRtMARY CONTACT: ❑OWNER �.QNTRACTOR ❑OTHER(Please Specify)
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<br /> ` �rONTACT NAME: - _,
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<br /> '���S�Ttti"'.Use of Builtlt�r' : Contract Price of Work;;� - . ' 1�> : .. �
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<br /> C�ropased Use of Buitdt�s '� ___. _.. Heat Source: OGas ❑Electric ❑Other
<br /> �uildi, �' e; , �Fi��p�tla�it,p,�; pSFR-Attached Q������ 0�����y;{ �ofUn ;.. ❑Commercial ❑Industrial
<br /> �of�'r �t: ��i� ❑Addition C1Remodel ❑�(e i� ❑T.i. �� � 'psi€�kier �Demolition I�Chan �.of Us�
<br /> C����I�IP"�`�i�'aL��',WORK: ..
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<br /> �SSOCIATED.BUILDING PEk�M,iT� ;;e� �cabie;-
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<br /> Ty�i�a€.of ProJect: _New _ Addn =Afteratlon _,Rapatr Type of Project: _,New Addrt Alteratlon `Repair
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<br /> _---,_.��Ldt�.t.�f;�J�t(ut�as.,_ : . '�.°�f�. ' : .......: #of � .
<br /> ' �' < Rxtures _.
<br /> A/C-Air Handlin Units #�[aat'�u , Toilet "
<br /> �C�vyF�r�+�� Inside Bfd j
<br /> � " orced Air 5 s�ems : �� �J��f�#� �: �Bathtuti;`. _ _ � ,:__ �� � � � .Urine) -
<br /> � ���:Aip� � ���� ��hower���Vt�a'sh�8asin " �:: � �iti�k�l� �Fountain _ �
<br /> Water Heater ` ` ' ` =
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<br /> Flaor;�rain ° ,
<br /> Gas Fire lace Wood�t�y�< ;;;;,, '"itchen fnk&Dis osal Gre,.ase..ra ' - "
<br /> Gas Ran e �i. . . ' Dishwasher `
<br /> Roof Drains
<br /> . �lothe..s D sr Nooku s: �, Other. Ctothes YVasher ' �ai . .�at�
<br /> an e Hood 'Vliater Heater �j�p :
<br /> Exhaust Fan �" " Sink .Service/BarlMo lete, ,> ' �..,
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<br /> ` Chemical or UVater `:
<br /> No._pf Heads
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<br /> ACKNOWLEDGEMENT,•/have reviewed this app/katron and contrm the(nfoimat/on contained hereln/s trve and conecL Work done pursuanf lo this permlt mus[compty wifh
<br /> �urt��ilYe<�'+�`�,ste�a,�nd(t�C�a►y 7(►�;�iny of;�.�r�tt pr�aufho�tzes approved worh and no devtatlars therefiom,DeviaUons musl Brst be au(horized!n writtng from the
<br /> 8�&diit�G��t b,a#"4r�byTt�q at�t�trpr�y�9d t�aa'sr any�tCt�mB{�nc�,,+am fha owner,or►am authorized by fhe owner of fhls property to periorm(he work for whtch appllcation is made,
<br /> and!comply wfth the Stafe Cont�actors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everetf Oti'icia!Usa Only
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<br /> � PERMIT� �� Q
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<br /> 'Uw �TAutCtort�AA. ��;al��� _ ,: Date;. � ,��r..��., .: .: _. '
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