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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL/ PLUMBING /SIGN I SPRINKLER I DEMOLITION
<br /> 1.11111. CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT.WA 93201
<br /> CP/125-257-33M I FAX 425-Z5T-335T j(E)ovo7attaosgavarattwa.gov 1 www.avarattwa govipermits
<br /> (Blue-
<br /> or Black ink Only Please4 - PROJECT ,Sii.E4NFtiRlilitikti014r.V: ''.:4'...2r1:'`i-7 `,
<br /> PROJECT SITE ADDRESS* l'i 0 Cresc.- A Jr" A N. ' PROPERTY TAX#:
<br /> ---
<br /> LEGAL -claw construc;tion. Snort i'lai,s,ithdriii,g ivii *_ _
<br /> i ot No. (attach copy of long legal description)
<br /> CONTACT:INFORMATION
<br /> OWNER NAME' 1p AirMlik II— if-) TENANT NAME If Commercial)
<br /> A
<br /> OWNER MAILING ADDRt..S' 6 °_...411k.. -.,A V......-
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<br /> STA-1
<br /> A....a wr
<br /> OWNER PHONE: - -7 ,
<br /> OWNER EMAIL;
<br /> CONTRACTOR NAME: t4eCki1'ri
<br /> CONTRACTOR ADDRESS: --.,..-, 14i °GAL°
<br /> ]f TY ft, 1 4,.. ..t*
<br /> STATE A A-- ?IP lir : 0 1
<br /> CONTRACTOR PHONE: 'ZCL 0 60 CONTRACTOR EMAIL et `-., 11 AA !A. nil .Co
<br /> _._„c,,,N_TRAc.,TR-LIGE4.4.5E-it(REQuiR ),_ -s. R - -iTY-OF-EVERETT SustNEsS LtrEMElt(REattfREDr---10(D CH- -
<br /> PRIMARY CONTACT: 0 OWNER t(CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> CONTACT PHONE: 4-25 25c/ 0551D
<br /> ,
<br /> De)cdo u2,
<br /> CONTACT EMAIL:
<br /> iteuiumiwRERMITAFfo-ititcatiamrAll-:,:-
<br /> . ,.. _
<br /> •
<br /> EK1S tin. Use of Buficiin•:
<br /> Contract Price of Work:$ alP 0 ii,
<br /> z•opo&-ed Use of Buildin :
<br /> Heat Sour:ter EIGas nifia.,,w, 00mer
<br /> _ ___
<br /> 3thilin T pe: OSFR-Det a:.-nej asFR.Atta;nej ODuorax 0Muiti-Farnit 4-of Units: _ OCornmercial Dindu-striei
<br /> ryoo of Proja:-.f..: ONew CAJJition ORamodei DReoa/r DT I. 03! 1 0.3oriakler E)ernoWion 0.-.7.haiTgo of Use
<br /> DESCRIPTION OF WORK:
<br /> "
<br /> 1•)1' 51—aiLZ h--(2--(24 . pu-yyip and, Cur Kandi-eria,
<br /> ASSOCIATED BUILDING PERMIT g uf a ag fi:-..;able):
<br /> MECHANICAL PERMIT APPLICATION ' --- ';:',',-pLuivisaNwp.EFimit4i0pLicAtioN
<br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair
<br /> #of .
<br /> r...ct of
<br /> #of
<br /> Li,s4-4atFixtures---- .--------thitof-r-ixtures
<br /> —
<br /> Frouras l'—i-Lg"f-b:Ixt44
<br /> Fixtures
<br /> .___.IIIIIIIIIIIQElrarammanlIltillIll._____ 'Toilet
<br /> Backflow Preventer(Instee Bldg)
<br /> in=Forced Air Systems Min nt, 'Ullianlinellr allinpathtub
<br /> Urinal
<br /> 1111111111111._____LEGE
<br /> =1nom Lavatory(Wash Basin) Drinkins Fountain
<br /> MN"a er tiMillliallilli Refrigeration an Shower
<br /> Floor Drain...........____EMMIN Wood Stove 1=11 Kftchen Sink&Disoosel Grease Ira
<br /> li............ as -an•fallillin Ducting
<br /> Dishwasher
<br /> Roof Drains
<br /> anum.Clothes D er Hooku.e SM.Other: MM.Clothes Washer
<br /> Medical Gas
<br /> IMMIN Ran e Hood allalnaillManm MN Water Heater Other:
<br /> 111111111 Exhawst Fan
<br /> • 111.111_111111111111111111 ME Sink(Service/Bar/Mo /etc.) Other:
<br /> 1111.111111111111111111111111111111111.111.11.111111111 inemi......111111.11
<br /> * SPRINKLER?SUPPREmin...,SSION SYSTEM ' '.'. ME
<br /> (CheMiCai Of Water 4,kr\ 11-leads, MN
<br /> A CHIVCWLECGEMENT:I have redinwdet This anniininicri er d chi:flan;the inlarnalihn ecntained twain Is true and correct Work done pursuant lc This permit rrld.st cdnzply will°
<br /> cutrent federal,sfaie and kcal lam The warding cl a p omat cily aarcrires acrrcved wak end fiC dewaticrs therefrere,Cevieticts dam:first be mithcrized in wdling kcal;he
<br /> alidill9 Ctial he/c. teirg euthcrized vi der any circurnstenm t am Me cwser.cr 1 drs atittcdzed ty Me cmler GI'ttis ptCPSttYtC rerferm MR work It,,4trci4 44tritcatinn is,,,.8,,,
<br /> A rd 1 ternply with the Z.7tabi9 Ccntranfcr Law le:7 PC V/ar4 2s6,2ccr.wAc.
<br /> City c/Everett O&M,Use Orly
<br /> PERM% 41,
<br /> "ALA 11. ...it,- •.1 1. i ' '' \ III
<br /> % —
<br /> Ow ertAuthorized Age Signature
<br /> Date.
<br /> 11Revmdl 9123407 6)
<br />
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