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<br /> (P)425-257- � FFlX A�25-257-88&7 j(�y evere�teps@everef_ ov J www.everetfwa.govlpermifs
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<br /> PROJ�CTSIT�ADI7R�SS: -- �" � � '`� PE�-OpCf�TY7'.4X�:
<br /> Lot No. (af#ach copy of tong lega{descriptIon)
<br /> L,�GAL.for new consfruction' Shor�P1af/subdivIsion -
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<br /> _ . • • . _• ' '- ' .' ' ��R��i`��$`'fl ,�1'_�r�11�d4�I�"Ii`��$!R
<br /> OVSJN�Ft.AdAPt�l11�~ '�� ., . � �,,) T�iVA�IT N��lt�{1T Commercial}:
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<br /> OItVAI�R IViAIL.ING/�BDRESS: srRE�r 1 �� ���� �� � f� ��„>2
<br /> � Si'ATE �V t� ZIP �LJ
<br /> Cln
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<br /> aCIUN�R PHOiVE; �'wZ, �` .,'� OW1��FZ�MAf[.:
<br /> coNTRACTOR i�IAiiflE;..C.�L--t�"�t ...,, 5. .�.,��•�•��.
<br /> GOI�[TRA.C�"Ot�ADDR�SS s�RE�' 2-�ZO ��-�= ��-
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<br /> c�rr � -� —'
<br /> ;ONTk�AG7'OR P1�OfU�; C�ZJ� °Z�Z` �[�t..�- COI�ITRACTOR ENIAII... t��-Q._.�����l C:.��=-=l-��''f
<br /> ;ONTRAGTOR LiG�IVS�#(REQUIRED} ���2�y��9-� �'s-�"—' � I�iTY OF�U�RET1'BU5INESS LICEIVSE�(�t�4UIRED): � E �
<br /> „,,. ,;,—r�., -
<br /> �RIMARY C~ONTACT��CI OWNER=y-..�CdNTF2ACTQR ❑ OTHER(P(ease Specifil)
<br /> ;ONTAGT NAM�: . , COIVTAGT PHOK�: (�Z� ,j�� ��j`�`�,.7,:�
<br /> q�-��� �� COMTACT EMA(L: '���4�`�5%���•1��� . . . • •
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<br /> _ . . . ..,. � . . � - � : �uit�rrl�.���zM��:�;���.r��,�[�xa � -
<br /> :xis�ing Use or'suilding: Confrac�Price of Work.� �
<br /> >ropased Us�n r`3,uiiding: IHeaz Source: Gas CIElecfric ClOther
<br /> luiiding Type: FR-ne�acf�ed ❑S�R A�tached QDuplex ❑Multi-Famiiy�oi Unifs:
<br /> ❑Commercial Cllndustriaf
<br /> 'ype of Project: ❑New QAddifion L7Remode( ClRepair }�T.L ❑Sign ❑Sprinkfer ❑Demoli�ion ClCnange or Use
<br /> i�SCRiP7ION C7F WORK. ���j�� ��ci���`�
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<br /> S50CI!-�T�q SU[LDI1�C P�RMIT#�(if applicabl�}; _ �� �
<br /> . : �.. - ���i�[���� �t���a�:������,����� �
<br /> .�{I�r��,�,�d.',����;:N,.;�.,�,rh�ddd�N�`�l'.�;(1�P,.1���;�7=���!!� " � _J�_- _--�._Meut ____Addn A[teration JRepair
<br /> �pe,oi projeci: "i�tew _... A��n ._.A�ferafton pair T'Ype o�ProjecE: ____
<br /> �of �of #o� Lrsf of Fixfures
<br /> �of 1.lst ofFixfures ,List ofFixiures ��xfures
<br /> Lisi ar"Fixiures Fixtures Fixtures
<br /> ixtures i oileE Bac.kf(ow Preventer(lnside B(dg}
<br /> A(C-�1ir Handling Units � t�eaz Pump ga�hfub Urinai
<br /> �orced tlir Sys�ems Unit Heafer
<br /> Sailer Lavafory(V�lash Basin) arinking rounisin
<br /> Gas Pip[i�g Snower �loor Grain -
<br /> Water Heafer R�irigeration
<br /> UVood Stove Kiichen Sinit&Disposal Grease'I'rap
<br /> Gas Fireplace Dish�vasher RooF Drains
<br /> Gas Range Duciing
<br /> Gfothes Washer Niedical Gas
<br /> C(o�i�es Dryer Hookups �t��'�� Wafer F[ea�er Ofher: _
<br /> Range Hood Oiher.
<br /> �xhausF Fan Sink(Serv�cel8ar/Mopleia)
<br /> �-�'= �6��p�4�tL-��.1��I���k��-��(1�_�d;�l`��`�`�6i�i,. . �
<br /> l�umber or"Heads
<br /> 'CiVOINLE�G�r19ElV7=�have reviev✓ed this application anci confirm one sf ar�ro/ved work and no devraibns thereirom�Uev afrbns must fr'rst bt�aulrhon'zed irr vr�'f rg frormwha
<br /> ent federal,stata,and locallaw. The granting of a permif on1y du h pp p p � p
<br /> c1ing Oir"�cia/before being auihorized under any circumsfance.!am ihe ov✓�er,or!am aufhorized by the o4vner of i'his ro e� to e�r"orm fhe yvork for�Nhrcli applicafion is ma s,
<br /> /comply with� e State Confractor.s 7 .27 RCW and 296.200A WAC ��fy or Evareft Offteial Use C]r,Iy
<br /> P�RIViIT# ��
<br /> t2_� _ j7 ��� ��- o
<br /> ` `� Dafe (Revised 512Q/2016) •
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