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ATTACHMENT A <br /> PERMIT APPUCATION <br /> BUILDING I MECHANICAL I PLUMBING l SIGN I SPRINKLER 1 DEMOLI <br /> CITY OF EVEREI 1 PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERFTT,WA 98201 <br /> ',✓` <br /> (9)425-257-8810 I FAX 425-257-8857 I(E)everelteps everettwa.gov I v v.everetttaa.govlpermits <br /> !(Blue or Black Ink Only Please) PROJECT SITE INFORMATION I <br /> PROJECT SITE ADDRESS: j t�(-t{ ' PROPEFiT3 T4:#: :19052 00040 99 00 <br /> ;LEGAL for new contraoton: Stort FIe aub,',svfa:o Lo:No,_ ,2usch c.,oy of Iona Aga:devmption) <br /> a <br /> ri�`, C©t1 <br /> CONTACT INFORMATION <br /> OWNER NAME: b RAe‹..----72- -- fv TENANT NAME(If Commercial): ; �y& - iftj US%-vIi 3 <br /> TOWNER MAILING ADDRESS: STREET 'ze�i .,V G AIJ t' <br /> CIT/ 74 L� 1 / STAT' 0+4 zP 5 bJ <br /> OWNER PHONE; 4 0'-' 93 3.6 ,OWNER£MAIL• h.,Zai"/Kee/76)&1:D/. CI 441- <br /> - <br /> ti <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: BEET i <br /> COY STATE - ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): Dirt OF EVERETT BUSINESS LICENSE*!(REQUIRED): <br /> (PRIiNARY CONTACT: 13 OWNER 1 CONTRACTOR )aOTHER(Pease Sperafy) 1 EWA/VT <br /> !CONTACT NAME: Ogifkt, al) 6- CONTACT PHONE: 4Z.c-- F79-'343'7 <br /> I CONTACT ENTAIL: v `"!(,z;> Lad,e6,.)tlij-Jl :c0"'.. . 1 <br /> 1 <br /> 4 BUILDING PERMIT APPLICATION <br /> 'Existing Use of Building: Ader 72,5 0 Contract Price of Work:$, lG J 000 <br /> Proposed Use of Building: R--eT,'-fl ,. Heat Source: MG-as LEiectric 00ther .___... ___-_- <br /> Buiding Type: DSFR-Detached CiSrYR-Attached DDuptex i3S,itat'si-Family4ofUnits. SCoolotere,ai QIstidustcizt, <br /> Tyoe of Project: 0 New IDAddiition DRemodel DRepair DT_I. DSign DSprinkler QDemolilon , Change of Use <br /> !DESCRIPTION OF WNORK: <br /> C br7 oris-77N 6- ,q7 .72i ? `2? (z4/x 30') R4 779,/z_ <br /> 6L4S5 S, P. I �.�' i6 Z /9tl-'fir r1,7 S. <br /> ASSOCIATED BUILDING PERMIT (if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> !Type of Project:_New_a, Addn _Alteration _Repair Type of Project: _New Addn _Alteration Repair <br /> n ofI <br /> List of Fixtures List of Fixtures F of j List of Fixtures m of List of Fixtures <br /> f=ixtures Fixtures Fixtures 1 Fixtures i <br /> PJC—Air Handling Units Heat Pump I <br /> +Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 'Bathtub Urinal <br /> Gas Piping Boiler 'Lavatory(Wash Basin) ]Drinking Fountain <br /> Water Heater Refrigeration ]Shower {Floor Drain 1 <br /> Gas Fireplace Wood Stove }Itchen Sink&Disposal Grease Trap <br /> Gas Range Ducting s 'DishwasherRoof Drains <br /> Clothes Dryer Hookups .Other: 1Clot'nes Washer Madicto Gas t <br /> Range Hood 1 tWaterte Heater Other: <br /> Exhaust Fan !Sink(ServicelBartfJfopietc., Other. l <br /> 1 SPRINKLER J SUPPRESSION SYSTEM l <br /> i Chemical or Water ! No.of Heads , <br /> ACKNOINI.EDGENI NT:.rave reviewed this eppkwLcc anti ccntir°n VIP it ormat n co,^tre+herein s rse and=Rect.work done pt S'JS t e Sfis.per.wittais c-rrrtrIy n. <br /> xruent federal,.state and Twat lax The grantcgof C permit only authorizes approved;hr and no deviations tharerrum.De-ia'ens must first be a ncadze'm wrialp'from the <br /> Fading Ofr.�tst be=cn,h_irg authorized wJ3:Ie anY r rWinslance lam the o.let orf am au homed by:the owner of this properiy to perform the work for winch papk„ation is made, <br /> and I camp::r ilh the State°ortreddor5 Lew 18.277 Rewand 296.2OOA:VC <br /> City of Everett Crala use Orly <br /> PERI-RT# I <br /> i Z312°III <br /> owner/Authorized Ag rt Signature Date {Revised 9,23/201a) <br /> (:.....„.....1____) { 2D <br />