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<br /> - ' CI!Y OF EVERETT PER11t��iT SGRVICkS
<br /> �,,�' 3200 GEDl�R STRE�T�EV�iZETT,WA sa2o1
<br /> (P)425-257-88'10 1 Ft��25-257-&857 �(E)everetfeps@evereiiwa.gov� �+rvv�v.everetfwa.gov,'p�rmits _ �
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<br /> PROJ�CTSIT�ADDR�SS: C - j� / PROPLRTY7'.,4�C+�:
<br /> LEGl��.ior new consfructfon: Shorf Piaf/subdivision _ Lof No. (attach copy of lony(egal dsscription)
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<br /> O11VtUCt�I�TAi4`!�= C 1 �..�-�T- TEtVANT 1V.tlN(E(IP Commercial}:
<br /> Q�j�j[�[ER,IV�AILIIVC�i ADD'RESS' 7REFT 7�t � N-'� (�i���y�G.�"'"�v `'" /� ' t,
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<br /> COAITRACTOR AlA���:�Ci7L�t�lZ-����.� ���,.L'��� � C�
<br /> GOIVTRACTOE2ADDR�ss: s�REEr Z-EZC� ;�-z-c-�L�-
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<br /> GONTRACTOR PHOt�E: �i-CZ,'j
<br /> ���_ �((c.{- COIVTR4CTOR E[it(AfL; i��%i'`CQ_L-`'��6't�'I t,�G<_=C`�F�
<br /> �.. . CITY OF FVER�TT HUS[IVESS LiGEP�SE�(R�QUIRED): ('Jj d���,
<br /> C01�3TRACTOP LICEC�IS�.f`i-(REQUIRED): ���(ZC.,,�<, ", i
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<br /> PR(]1t1ARY GONTACT ❑OW�IER �CONI RAC"COR I�OTFlER{Please Speciiy)
<br /> CONTAGT 1dA1VI�': _ GOMTACT PHON�: �Z�-) S�P�G -�>�7�=�
<br /> ��i�t°� �t-E:, CONiAC�'EMAIL: ��.-��SS%7''�U..���.�J,�'� .
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<br /> Exis±ing Use of Bui[ding: Confract Priee of Work;..�--- f-"'
<br /> Proposed Use ofBuilding:
<br /> �NeatSource: F_iecfric Oiher
<br /> Building Type: ❑SFR-DetacnEd ❑SFR-flitached ❑Dupfex ❑MulTi-Famify-fi o;Units:
<br /> ❑Commercial ❑lndusirtaf
<br /> Typ�oi Projeci: ��lew T�P�ddifian ❑Remodef ❑Repair L7T.1. ClSigt� L7Sprink(er LlDemoliiion CChanye of Use
<br /> DF_SCRIP1�IOht O�WORK;C���* ` f E (J(.,�r �l �'l�C.t.�'�C- ��'�'�'
<br /> ASSOC1Ai L-:D BUlLDIMC PERN(fT:�(if app(icab[e}: _ -_-
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<br /> Type or`Projeci: _,New_. �ddil ___.��terat.ion .JRepair Type or Prol�c.f: New Addn ^1alfera[on ___,Repair
<br /> �o�. ��r �or" �ps�or'Fiafures
<br /> �°J Lis�of.Fixiures l.isi oi F�ciures �.ist oi FixfurE� Fixfures __.
<br /> Fixtures rixfures �Fi�ures
<br /> Toi(ei �ack io�rJ Preven�er(lnside SId9)
<br /> f�.lC-Air NanGfing Uniis Neat Pump , Urinal
<br /> t"orced,4irSystems , Unii Hc-a�er B��i���u � 1 �.
<br /> BDifeC L�vaiory(��/ash 3asin) Cr;r,king�ounfain
<br /> Gas Piping F1cor Drain •
<br /> Wafef Hea[2r Reirgeraf(on Snower --�
<br /> r � V�!ood Sfove Ki�chen Sink&G'tsposal Gre�se Trap _�
<br /> Gas Firep:ace RootDrains
<br /> Gas Ranga Ducting Dishtvasiier _ -.
<br /> � _ Ofher: � G!othes UVasl:er P�edical Cas �
<br /> Cfoihes Dryer Nookups V�'ater Hea�er Ofher:
<br /> Range Hood � �
<br /> rxhausf Fan Sink(Servicel6ariPsiop/ef) Ofher' —�
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<br /> - Number of Heads - -- _ _ _ --_ --- - - _--
<br /> �CKNOWLEDGEMENT.-l have rAvrewed rlus�pp�li��tio��n��ly�aurhn�c e.approrved�orlc and no dev�t ons iherefirlmtDevations musf f�rscG�a aur7��ized irpU riiiny�on tf i
<br /> :ur�entfederzl,sfate,andlocallav 7hegrznti g p
<br /> �u1(diny Or�c(a!baiore 6eing auJ.orhed urder any circumsfance,I am ihe cwmer,nr!am auinorized by ihe ov✓ner��f fhis properfy!o perr"orm the work:or vdhich appUcafion is ma r�
<br /> nd!comply wifh the Sfa(e Contractors!_aw 98.27 RCW and 2.96200A VI/F,C. City of E✓ereff OrYtc;al Use On�y_ _
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