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17'1 <br /> T.:4kt', <br /> i0100' . ,. ., . . ... . . <br /> CITY OF EVERETT PERMIT SERVICES a <br /> f <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 1Blue o Blade Ink dntly please}:° ,PROJECTSIT0N$1, 'l§ , I .. <br /> t; <br /> RO € E: - <br /> A SS: /0/.33 -tl ti k t-34,1 $ WE R - : 25D4 240020 32G 0 <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> _ q ,.,... .. E. . rt. , . ' 1 0C� tA�"I'tgt; ItI11�111TiQN �,..,r ti.. ,.. .,a ,. _ _ _ o <br /> OWNER NAME: 8 CAN.A-j-2_,O v 6L4.S(...>19-GOA) TENANT NAME(If Commercial): `5 jf <br /> WNEW AlttNG A DRESS u IREir/4C) 72.4.3 o AUi . <br /> orty ED t AADS MAT w A zP 1$02 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: `ZE,E O k -own) I +tvwS ep/V 5712(..1 CT(OA) <br /> CONTRACTOR ADDRESS: •.STREET 4i 0( 4L -JI ,IO <br /> CP.2 T-I— LL7 A- 99201- <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED n r <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 'OTHER(Please Specify) // <br /> I ONTACT NAME: I ONTACT PHONE: .3W- 94 t _c1 <br /> f�L '� u,02 CONTACT EMAIL: -`i L D R-0eS/41A)A- C)-I 11 V •fe)rt i <br /> ;; BUILD NG. RIM"IT*0*4CATION i <br /> Existing Use of Building: ,-t t rb / A-/tj Contract Price of Work:$ PSs 68-o <br /> Proposed Use of Building_ ‘' t,-hA ft— Heat Source: DGas QElectr c -•❑Other /36 NE <br /> . tr er ` in <br /> 1i3ii(ttiftg� St=R- fad . �.�F�#t� nflupiex `Litilt�Fa -7#�fUt : <br /> Type of Project: ❑New RAddition ❑Remodel ❑Repair ❑T.I. 13 Sign CI Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:„ <br /> Av57-12 L i ,1 ►M- - A-C - .62.101-lYt f t l) I stop <br /> )g )C3al <br /> 'ASSOCIATED-B.U.ILDING-PERMIT#(if-applicable);_. <br /> MECHANICAL Pt.**f "APPU0AT1ON " PLUUMBI 1Ga.PERMIT APPLI CATIO 4" , <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New Addn _Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixture. List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtun3s Fixtures <br /> A/C—Air Handling Units ;HP ; ump iToilet .Backflow Pr-._nter(Inside Bid ) I <br /> Force .Air Svstes _ Unit-;Hater .j -;Bathtub .:`� "..d, i <br /> dni <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& .. •osal Grease Trap <br /> Gas Ran•- Ducting Dishwas•- Roof Drains <br /> ) 'Clot Dryer.Hookups 'Other: C C. -s Washer Medical Gas <br /> --nge Hood ! 5.5. t .Water Heater 1 Other: E <br /> :Exhaust Fan i_. 1.,1, [Sink( er ioefBar/ opleto.)'_.: Other: <br /> SPIz1N1KLE1:(,SUPPRESSION.SYS*I1:> , <br /> 'Chemical or Water I No.of Heads <br /> __+ <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> wilding Official before being authorized under any circumstance.I am the owner or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the`Siete Contractors-Law 13.27 RCW end 2964004 WAC.. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /0(1 <br /> !�J2cJ1 e io 10 <br /> Own orized Agent Signature D (Revised 9/23/2016) Y <br />