|
PERMIT APPLICATION
<br /> BUILDING /MECHANICAL/PLUMBING(SIGN[SPRINKLER I DEMOLITION
<br /> Igt1
<br /> 141011Wf CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 9323t
<br /> CP)4-Z3-257-3310 I FAK 125-257-335T I(E)svaratteosvarra.gly I wt,vwevEb.c. ft...wa gwipe;mi's
<br /> (Fift.ta OCBlack kik Only Please
<br /> PROJECT SITE ADDRESS: 0 el 46,4A Jo! PROPERTY TAX g:
<br /> -__---
<br /> LEGAL f3,- 1-,,, -..rtst ,tc:tion, (attAch:;opy of long legal riescnotion)
<br /> CONTACT INFORMATION
<br /> OWNER NAME. ,....4 •
<br /> TENANT NAME Of Comm - at
<br /> 1
<br /> -------7
<br /> OWNER MAILING ADDRESS sr-r- I 1 0 • 4aba •
<br /> do do —
<br /> .0
<br /> , • 0
<br /> •r, e, if).11
<br /> 3 TA i 7 a
<br /> A..... .AP
<br /> OWNER PHONE: -1 ti 9S
<br /> OWNER EMAIL:
<br /> .w+4
<br /> CONTRACTOR NAME. rY\ ,...aiii -
<br /> CONTRACTOR ADDRESS: 3,'2EST 14 .
<br /> vw Z
<br /> c.,:r,, low • „,.t.Zt" a7ATE A a' 0 I
<br /> -3 fit-
<br /> CONTRACTOR PHONE: 2. ct 0 SO 'CONTRACTOR EMAIL-of Ap it ! 10 jA !A ft .corn
<br /> ---- 7 NTRAG-TQR-LIGENsEAREQui,--, v • - -0E-dVERErr-BUSttstES31.10ENSEUTREI . ofoct-g"
<br /> PRIMARY CONTACT: 0 OWNER IY(CONTRACTOR 0 OTHER(Please Specify)
<br /> ---
<br /> ____________
<br /> CONTACT NAME:
<br /> CONTACT PHONE: 1...t..2.5 2.5• 050
<br /> ,
<br /> Delcdo uz-
<br /> CONTACT EMAIL: t Ap 4 Lk * • 1,12a, 0
<br /> . _ ...,.... , .
<br /> .rf ;•:_. --•• : :,, uiLtutio-P,'
<br /> wk.
<br /> Pi-oeose.j U.3.9,of 3tiiiiin : Heat Source: iii"P DE137.tri.--- ODthar
<br /> 3ufflin, Tyos: 03Detachei 03FR-Attar_mei 0.DilofeK' 0,Multl-Family-ff-X nits 0Commarciar Olnaustnal
<br /> Tyoe of Pje.::!: 0 Neve 0Aiition OR: rn:Y.13i 0 ReDarF OT f. 03, 1 03ormivar 0Demo1ition 0::Tha,1 e of Use
<br /> DESOtRIPTION OF WORK:
<br /> lic4epLaciz_, ets Ft,f-ruce_
<br /> A333ATS,D BrilL.DINCi PERMIT ff(I az3oVtajlet-
<br /> ilitECHANICACP1E1ll‘iter-APPLICATION • '• ,-( ' - -- -.- 'l-; PLUMBING'..BRNIMAPALICATION
<br /> 'tide of Project: New Addn Alteration Repair
<br /> tan #of
<br /> of #of
<br /> List of-Firtvras--- —
<br /> MUM Fixtures NC-Air Handling Units Mill Heat Pump ...._._11111111111EDMIll....11111111Bakflow!raven*(Inside Bldc)
<br /> MIN Forced Air Systems 11111=MEMEN BathtLanniumumminimil..Urinal
<br /> NMI Gas Piping Boiler MN Lavatoty(Wash
<br /> ati' mRoilmlakitcmheg.n,mBasin) MDnking Fountain o
<br /> u
<br /> ntainEMIZMMR figeron Floor Drain. Wood Stove Sink&DisposaMGrease TrapRan.
<br /> lailliOuctins isnimmima '
<br /> NMI Roof Drains
<br /> ......Dshwasher
<br /> IIIIIIIII Clothes Dryer Hookups 11111111.L........ IIIIIIIIII..__rfcthes Washer MOM Medical Gas
<br /> ME Ran e Hood 1111111111111116mmomm XIII. - - -euLwilaitpuilimmiliiiiiiiMIIIIIIR Other'
<br /> 11.1111....._EZEMOMMINIMINIMIN.11111111111 111.1111.m...._____sink(Serviceisar/Mddieic•;11111111111
<br /> 111111111111mmemimillillillilling. muumming......111111111111
<br /> spi4INKLER'isurpREssiou sysTENT . .. ,..........____ _111111111....6...
<br /> Iii Ne.cf Heads IIIII1 111.11111111111111.111111
<br /> ACKNOWLEDGEMENT;J have reviewed this appacadcr ard centum the infcrineticn ccriaired herein is true and correct Wcrk dare pursuant In this peat 17111Si ccrapy With
<br /> an-ten/federal,state,and Inca/taw, The granting de remit city authcrizes arrrcved vvcrk and cc deviations Therefrom.Deviaticns rrusl first Le authcrized in veiling frrm the
<br /> 6tti/r/ing Cfrxiait efcfa t eing authcrized under any circumstance.I am The cwrer,Cr!am euthcrized Ly the cwrer c/this prc ,rty t,p,ricrm the,,.„ry,kr which acrkalicr is rree,
<br /> and I comply with the State Contracicrs Law le.27 FUN and 25E.2GGA WAC
<br /> e
<br /> City cJ Everett Cfficial Use Crly
<br /> %411P U. Alk I
<br /> ig l`b t -ur i
<br /> Cw,eriAuthcrized Age' Signature
<br /> (., ovlseri 9/23(204)
<br />
|