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Feb 16 16 05:05p Rell's Refrigeration 765920179 p.1
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<br /> •7-/E7 PERMIT APPLICATION
<br /> BUILDING / MECHANICAL I PLUMBING I SIGN / SPRINKLER I DEMOLITION
<br /> CITY OF EVERE I T PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 99201
<br /> (P)425-25/-8810 I FAX 425-257-8857 I(E)everetteps@cyereltyra.gov 1 vnrnv.everottwa.godifxrnnils
<br /> PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 1 L{ c Lo.,, ,,,- . a\kr`PROPERTY TAX#:
<br /> LEGAL for new constrJction: Short Rat/se hdivis:on _- _Lot No_ (attach copy of long legal(ir:scription)
<br /> CONTACT INFORMATION
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<br /> OWNER NAME: J+y\ ij i Lc.b`^!",4_.-\.4.1, -1,t ---TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: SOLI 1 0 j 1___,O7ty\) z`�, (�(-'
<br /> ,Y Hwy 4c sier_ �n Te".` �L` .
<br /> OWNER PHONE: (� OWNER
<br /> EMAIL: '
<br /> CONTRACTOR NAME r' S r 1 ✓''� 'v--c ;,O> ' t �-t�c�-- c�/.- ,,A� L-L�
<br /> CONTRACTOR ADDRESS: STREET J,4 '`. 3 a� , w S
<br /> COY Oe.s (t - re, s- uric JJ no
<br /> CONTRACTOR PHONE: :3,(,�-'--tY.L(n—I�rL(�,4 �COONTRACTOR EMAIL: ( C 1�5V^ r. ✓✓1 C �C_• p hfr }
<br /> CONTRACTOR LICENSE ite(REQUIREDI:y2��s-S I� I4 Ci. 1 .,J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�/ 3�irt'
<br /> PRIMARY CONTACT: E OWNER IikCONTRACTOR 0 OTHER (Please Specify) y
<br /> CONTACT NAME: CONTACT PHONE:c9_,(:) .:; 1.3 -k.c.�k-e iC
<br /> e1--v 1` \A 5 l;c�, _ CONTACT EMAIL: �M �� (",,f ✓': C L�C,vti�-,-i V�, 1_
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<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ /Qa•`'�
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<br /> Proposed Use of Building: Heat Source: NCes ❑Electric ❑Other__
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Mu ti-Family-;l of Units: ❑Commercial ❑Industrial
<br /> Type of Protect: ❑yew DAddition ❑Remodl ❑Repair ❑T.I. ❑Sig/n ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: tar.y`. iC' tic--\-\-4-5 U. t� V-c-1 La��.C: 5 o '-' ,j,�vx,,�:- d,LA„ J
<br /> JV4 'I,.t{ 0,-,;,1k /' °I
<br /> �!kms{ a-�✓ �7^ f:1-J".."-v\-A'C'1j $ f:1-J".."-v\-Af:1-J".."-v\f:1-J".."-v\-A'C' C
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: New -.�Addn Alteration Repair Type of Project: New Arkin Alteration Repair i
<br /> #i of #of List of tures List of Fixtures #of List of Fixtures #of
<br /> FixList of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units Heal Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal 1
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireolace 'Arood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher _Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: _I
<br /> SPRINKLER/ SUPPRESSION SYSTEM
<br /> Number of Heads
<br /> ACKNONQ EDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this fxe•rnC must comply with
<br /> current fixk rat,slate,and local law, The granting of a permit only authorizes approved work and no devioticns therefrom-Deviations must fast be authorized in writing born the
<br /> t3uikling Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this properly to perfwrn the work for which application is made.
<br /> and I comply with the State Contractors Law 10.27 RCA,:and 296.200A WAC.
<br /> Cry of Everett Official Use Orgy
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<br /> ��� PER T# 1 �n
<br /> Owner/Authorized Agent Sign.,_,,,„,14_ , . , ,P, L },
<br /> atu Dab (Revised 10/12/2015)
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