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PERMIT APPLICATlON
<br /> BUILDING / MECHANICAL J PLUMBING !SlGN i SPRINKLER I DEM�LITiON
<br /> -:':� • ClTY OF EVERETT PERMIT SERVICES
<br /> 32d0 CEDAR STREET.EVERETT,WA 98201
<br /> (P)425-257-881(l ( �AX 425-2�7-8857 �{E,}..everetteps@everettwa.gov� www,everettwa.gov..lpermits
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<br /> �Niu�-or�1�tk.�nk�t# �� . PRO.IECT SITE 1NFfl��lTlOi�
<br /> PROJECT SITE ADDRESS: ,�Z � � .`. � : ` . , � �.� -: �' �ROPERTY TAX#. OD 4�<' �,��.,�
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<br /> LEGAL tor nev�r cnnstruct�on: ShcK Piatisubdivision _ _______� � __Lot Nc�. (aitach copy of iong(egai description)
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<br /> CONTACT�NFQ�AT:�ON. _
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<br /> OWNER NAME: '�-, ' : TENANT NAME(If��Sitiitlt�f�1�1;
<br /> OWNER MAIUNG ADDRESS: srHeer , ;' '` :,.
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<br /> Si'Ar� � .;.��� ZIP �. , � .
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<br /> OWNER PHON�: ,, �LO(p � , ' �1� ; 1 ,
<br /> �� $'�T�T� OWNER EMAIL: _'"1 � `_ �
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<br /> CONTRACTOR NAME CO+� �ST'�/i/,� ���}�`�,�JV;' .. /NG
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<br /> CONTRACTOR ADDRESS: srReer /7G.Zy Id'�h fiv�yi,�,� �'� �tt�f�
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<br /> �ONTRACT�R P.HONE: +�"'. �cS�",-= CONTRACTOR--�lYlti4i�;:,� ; ;, , j ..�.., '�
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<br /> �ONTRACTOR LICENSE�REQUtRED): +L'Q�' t9�,C/YJ �Yt"�OF�vERETT B:U8INESS_UGENSE-�(��C�1�1�l�Lt�_D.��"'�
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<br /> �RIMARY CONTACT. ❑OWNER L�'G�ONTRACTOR 0 OTHER(Please Spacify) �,��m�
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<br /> ;ON7ACT NAME6 CONTACT PHONE: —yBS--O//j
<br /> cJAR� �",.OJPNIS�� -'� F��/C� �ANAUF� CONTACT EMAIL _ : ��
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<br /> ��LD�N� P�R�T AI�PL:��ATION :' ,
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<br /> :�i�t��sUse of Buildi � '�• , .:' r . Contract.Price ot Work;,$. ��,p0 ,
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<br /> 'tci,�setl Use of Bwld`tttg: _ Heat Sou[ce. ❑Ga5 ❑Electric QQther.
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<br /> �. e� , ,�FR-Detached ❑SFR-Attached Q�t.0 l�it 014�4��� �•of Units. QCommercial ❑Industrial
<br /> 3uildin =
<br /> ' �of Pro��t; ONew �Addition .�Remadel , "��i^ C7T 1 � "°�°' 0� �� ❑Demolition �Cha , e of USe
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<br /> )ESCRIPTION OF WORK: „„ _
<br /> : 14�• I'��Yl'lOV�e. ��mL� �r �1�C'.P.� �CJC�lt L�!�'rY�'I�
<br /> ; ►SSOCIATED BU{LDING PERMIT# 3€"" kicable:!, _
<br /> MECHANlCAL P�T APPL1CATiON `: PLU�IN�P�T:��,GA'�QN
<br /> YPe of Project: _New _ Addn �Alteratian FRe air ''T ` `
<br /> p ; ype af Project: _New _Addn Alteratlon _Repair
<br /> c.#of List of Fixtures #�f List of Fixtwes : .#°f Lis!of Fixtates �°t Ust of F)xtu�es
<br /> , �xtures Flxtures Fr�rt�res Fixt�res
<br /> 1�7C-Air Handlin Units Heat Pump Toilet ;; '
<br /> 6ackflow Preventer Inside Bld ,
<br /> Forced Ai�S stems Unit Heater �athtub. � U[tnal "'
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<br /> . Gas P� !n ' ' Boiler Lavato Wash Basin ...... ., Drinkin Fauntain ,;; .
<br /> ? Vltaier Heater ` Refri eration Shower ;F.I..00r Drain:,,
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<br /> : Gas Fireptace Waod 5tove ;Kitchen Sink&Dis osal �rease Tra
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<br /> ; Gas Rar► e ' Quctin '' '�3ishwasher Roof Drains
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<br /> ` Clothes D er,Hooku s, °` ,�ther_ � " ; ' Gloihes VUasher Medical Gas
<br /> Ran e Hood ' � ' ater Heater . Other: __ -;
<br /> Exhaust Fan Smi� Servicel6ac/.Mo lefc. . Other:
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<br /> � SPRINKLER!St�P-.PRESSION SYSTEMI�. _
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<br /> CKNOWIEDGEMENT.•1 have reviewed lhis appHcation and confirm the information contained herein is irue and correct.Work done pursuant ro this permif must comply wilh
<br /> € rnenf federal,staie.and focal law< The grantiny of a permit only authorizes approved work and no deveafions therefrom.Deviations must first be authorized in wnfing fiom fhe
<br /> � .�itding Otficial be%re being authonzed under any cercumsta��ce,.f am fhe owner.or 1 am authorized by the owner oi fhis property to perform the work for which application is made�
<br /> � id 1 comply with!he Stafe Contracfors Law i8,27 RCW and 296;200A WR�;,:
<br /> �'°of Everett Officia!Use Only
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<br /> o PERMI
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<br /> t�ert t�i�Qrtaptt AgenC Signature , 6ate _ tF�ev�sdl�"a�2d�}t�)'
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