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BUILDING ! MECHANICAL EPMUMBiNGCATION
<br /> WIlb1 /SIGN /SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT WA(38201
<br /> (P)425-257-8310 I FAX 425-257-8337 1'tE)3VErattaasgave, ttwa_gav 1 owwv.everettwa govipermits
<br /> (Blue or``Btack Ink Only Please) �,
<br /> RCJC1" ?itE�ItVFC3tiV}A`t' t71�: ,
<br /> PROJECT SITE ADD ,`, �-
<br /> RESS: "
<br /> LEGAL for i�ew oor�si action: short?la;,1a� ; n ASA al PROPERTY TAX#:
<br /> ____.- Lot N . (attach copy of long legal description)
<br /> CONTACTINFORMATION =
<br /> OWNER NAME:
<br /> ■w' TENANT NAME(If Commercial)
<br /> OWNER MAILING ADDRESS' c,-,,,,- 1 {
<br /> t ll+ANhh.� t• i
<br /> OWNER PHONE:
<br /> MI-z: VIA Tr • ' el
<br /> t► +i
<br /> t�� I OWNER EMAIL: �'_
<br /> CONTRACTOR NAME: V,
<br /> It-Ifack,i'n Inc.
<br /> CONTRACTOR ADDRESS:
<br /> CONTRACTOR PHONE: 2. -JCI, STATE a. Z1' * : 20 I
<br /> SC) CONTRACTOR EMAIL. ,r`,* 4 % + A4 ,► M 1.n .CO
<br /> ._....._CONTRACT9R-C.tCENSE-#kREGU?RO)t-._... �-yy
<br /> Alit ,a". R __ erry-of~eveReT•rsunless-rm.-me ItCREOUIREDr
<br /> PRIMARY CONTACT: 0 OWNER t 'CONTRACTOR
<br /> 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> T1„1,��, CONTACT PHONE: , 25 ZS 0550 C'r',,
<br /> L�irJ�J CONTACT EMAIL: ,� a a - sJ v
<br /> w Co•
<br /> ilio*17.-1 fi ..� '3 i }i�l?'si 'R3rre:7c',+ A_.
<br /> Existin Use of Buntline:
<br /> �rpos34 of Sutid(n., Contract Price of Work:S 2_00o
<br /> IMERI
<br /> ; �
<br /> r ■• h-
<br /> ...,_
<br /> T
<br /> ~SuEl3ih T ( S -D r LI3FR A tach3d ❑Dllotax- CMui,i- aniiyron � CComm?reiai Olnduatria!yoaOfaoe_ ❑New ❑Addttton ❑Remodal QR'�airOT.I. 03i i 03prinkler ❑Demolition CIChange of Use
<br /> OF WORK:
<br /> { 1
<br /> ASSOCIATED BUILDING PERMIT 4 _a .m cut r' r 1, �('ed
<br /> �
<br /> (if <3 ii,.3,7?}.•
<br /> MECi•l4NIGA[:;PEIti4'tiT.AP.P�.tCATIC1t+,T" .,",°,
<br /> ansuciUM �� y i i*P/ `C T O
<br /> ,�yy �w I: �M1JQiEldiyl":: IRI1[E`:'sYi'�L�4f�wlMfj�.dN
<br /> Mninizin
<br /> -.,fid ray----" Milletilial fi of .,
<br /> FtXtures Elul of-fix tures-�.-
<br /> mom Forced Air Systems Thiled
<br /> Urinal
<br /> MIN Gas Piping Bathtub Preventer Inside Birk)
<br /> Lavatory(Wash; asln) Drinking Fountain
<br /> Gas Fireplace _Rfri.aratlonShower
<br /> Floor-!t Wood Stove Drain
<br /> Kitchen Sink&Dls-osa[ Grease Trap
<br /> Clothes 0 er Hookups Dishwasher
<br /> RoofRan a Hood Clothes Washer Medical Drains
<br /> mum aMmuilmmillill11111111111111 Water Heater Other: Gas
<br /> WIIIMIIIIIMMIIIIIIIIIIIIIIIIIIIII.111111111111111111111111111111 allinillIIIIIIIIIII
<br /> Other:
<br /> SPkINKLE tYSUPPRESSION SYSTEM ", :' ,.,:
<br /> Chemical or Water
<br /> Nc. cf Heads 111.11
<br /> ACKNOWLEDGEMENT:I have reviewed this epplicaticn end ccnfirrn the Information contained harem is true and cement.Werk done
<br /> cv'"'enl7`edaratr,stare,and local law. The
<br /> Eutdir. r^ grantingof a pp property
<br /> g �fTcfal before teing authorized under any circumstance.tam the owner,or sir,auihcrized t:y the owner of this ro erty tc perform the work for which application
<br /> Permit only authorizes approved work and no deviations therefrom,Deviations must first be au[hcrfzed In writing pursuant to this permit must comply with
<br /> and I comply with the State Contracicrs Law 18.27 RCW and 25.5.26CA WAC,
<br /> g from the
<br /> is made,
<br /> Cii cf Everest Cffcial Use Cnfy
<br /> .+,..•.L 1 PER,IxI
<br /> taw.eriAuthprtzed Age I `re ,"� - v Y \ x 1
<br /> g Signature ' 1.__. ,171...4011..,
<br /> 1
<br /> Gaffs (Revised 9r23I2C76) V
<br />
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