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PERMlT APPLICATION
<br /> BUILDING/ MECHANICAL!PLUMBING/SIGN /SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 96201
<br /> (P�425-257-8810 � FAX 425-257-8857 �(��?everetteps�everettwa.gov� www,everettwa.gov/permits
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<br /> �PROJECT SI7E ADDRESS. �� �:- -:},��, PROPERTY TAX#:
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<br /> LEGAL for nsw construction: Short PlaUsubdivision. ._ Lot No. (attach copy of long legal description} _
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<br /> t}U�t�[E�#i NAME;, �» ._C �r � ° .::.:. TENANT:NAME ��i[�1Yt�i��; __
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<br /> �3#lfN�Ft MAILING ADDRESS,.: s���T
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<br /> Q�ER PHON -
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<br /> CONTRACTOR_NAME; �" :`
<br /> CONTRAGTOR ADDRESS: srneer �I ;
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<br /> C�1M7'i�Cfit�R PHONE:._ '. ,�
<br /> � � (;� ��..���,��. CONTRAC70R EMAIL ��h�: ��"y'�
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<br /> 3CL?NTRA,GTQR LlCENSE�¢f�CEi;fff'a�t3);�}�'�l����� CITY OF EVERETT BUSINESS LICENSE A�(REQUIREDj. ��;��::
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<br /> �RIMARY CONTACT: ❑pWNER 'CONTRACTOR ❑OTHER(Please Specify);
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<br /> CONTACT NAME: �tlt�'1`�pHONE � ,�'�. , -�
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<br /> Existing,Use of Buiidin :,,, Contract Price of Work:s 1 a d DO
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<br /> 'Proposed Use of Buildin : �ti3���pU�GBF �t��s 8ctric ❑Other
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<br /> ' �uPldt' `�" ; , ��i-�etac#t�il C�SFR Attached C1L�u 1+�c` : ❑Mu11�Fat�t I =�of ttnit�: OCommercial �Industrlai
<br /> � a of t�r,ci$t�:::❑New �Addltion �Remodel C�l�:"'air ❑T.I. �S rt Cf�" kt�lr O_DemoJition ��', �of Use
<br /> ����IttPTION OF1�F#F� _ I
<br /> ' �.�SI�Ce�JI. ln.�.�- ��t,�rn� S�s�rn
<br /> ' ���ia�l`��i BUILDING PERMIT# �`. ' i��tl�:i '
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<br /> I�A .CH�`11����. .. P_. ._�..:�"�" , ��"L �/�T,!7!. PLU„M�1N�i���ti1tT,APP4��ATli?N ;
<br /> Typa of ProJact: _New_ Addn AReration ,,,_,Repalr Type of Project: `New Addn rAlteration"_Repalr
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<br /> LJst of Flxtures �°f Llst of F/xiures #of Ust otFlxtures #of Llst of FGcfures
<br /> Fixtures Ftxtures Ftxtures . Flxtnres
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<br /> AJC—:Air Handfin UrSits ( Heat Pump oilek �acktlow Preventer inside Bld
<br /> _ Forced Air S stems Unif Heater ' ' ::BatM�b Unnal '
<br /> �as Pi ing 6.oiler " ;Lavat� ::(Nlash Basin� ` Drinking Fountain
<br /> Wate�Hester ' Refri eration Shower ' F1aoi;Drain "
<br /> °' ��s Firs lace, °, : iNaod Sfove Kitchen Sink&nis osal ' Grease Tra ' ``
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<br /> Gas Ran e ��c#(n , ' _ ' D'Ishwasher Roof Drains
<br /> Clofhes D er Hooku s ,- . . Other: Clothes Washar " Medicai Gas .
<br /> Ran e._Hood Water Heafer " i�the�` ` " `
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<br /> ` EXhausf Fan ; ;Sink Service/BadMo /etc. Other. - "
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<br /> r '�$ ���...��.t.�� �..,. , • � ; _ _
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<br /> i�hemical or Water No.of Heads'
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<br /> ACKNOWLEDGEMENT.•/have rev/ewed fhis apptJcafion and conl/rm ihe lnlorma►ion contained herein!s true end correcG;kI�SJ�ik done pursuant to thls permit masf comply with
<br /> cunenf federal,state,and local law.The grenfing of a pe�m11 onty authorizes approved work and no deviatlons therefiom.DevJatlons musf llrst be authorized fn wrRing from the
<br /> Building Ofllclal before being authodzed under any cficumslance.!am the owner,or!am au(horized 6y the owner of thls pioperty to peAorm the work for which apptication Js made,
<br /> and I comply wifh the Sfate Contractors Law i8.27 RCW and 296.200A WAC.
<br /> i � _. Li6�of Ever�tt O�Fial Use��3rr�y
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<br /> f�+,�rliarlll�fhorised<,�8t�f 3lgnature ' ___ � ; : ;-, `
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