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BUILDING!MEGHANICALE P'LUMBINGCS GNN���INKLER/DEMOLITION <br /> GITY OF EVERETT PERMIT SERVICES <br /> 32D0 CEDAR STREET,�VERETT,WA,982U1 <br /> (P)425-257-881 U � FAX 425-257-8857 �(E)evereiteps@everettwa.gov� www.ewerettwa.govlpermits <br /> (Bt�ie:ar.Black 1nk Ot�ly Ple.a�e} .. PROJECT:SI'fE:INF�RMATI�N <br /> PRWEG"f SITE ADDRESS: � 2 � � PRfJPERTY TAX�:I����I�j'�Z sO �OO <br /> LEGAI.for new Construction: ShoR PlaUsubdivi�ian` Lot No. (attach copy of lomg le�l description} <br /> � �. � h <br /> `"" �CONTA,CT It�FORMA�ION` Y <br /> OWNER NAMEt �j � C('j(7 TENANT NAME(If Commerclal): '" <br /> OWN6R M/ULINO ADORESS: srr��r C7 � �Z O 0 <br /> cnv � srnr� � <br /> OWNBZ PHON@: OWNER EMAI�: <br /> CONTRACTOR NAME; � r( 5 l � �_ � ��� / <br /> CONTRACTOR ADDRESS: s�er S• <br /> crtv � �e(' srnr� � � �o�� <br /> CONTRACTOR PHONE: f,Q(� - �� - �'J a2S CON'fRACTOR EMAIL: � <br /> CONTRACTOR UCENSE#(REQUI RED): - �j�� CITY OF EVERETT BUSINE38 LIC�ISE�f{fi�QlAl2ED}: �� � <br /> _._�. _�. .�. _ , �. __ �. . <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑O'THER(Flease S'peCtty) <br /> CONTACT NAME: CC�NTACT PHONE: � � � � —� �.. <br /> � �i��iC l \ 6 c�.� CONTACTEMAIL: S� � �� M � <br /> ,..,. _ . . _ <br /> BU.�C.D1NG'F.�RMIT;AP�'LICATIO�f ' . <br /> �� � , � _ . <br /> _;. <br /> Existl ua�of eul�a� ; cormact Price of wor�c:s 2..�a O D�t� <br /> Pr osed Use oi Buildi : Meat Sourte: �Gaa �7El�tric ❑Oth�r <br /> Buildi T : ❑SFR-Detachad OSFR-Attach�d ❑Du lex ❑Muld-Famil -#of Units: �omm�rcial C7lndustrial <br /> T e ot Pro t: ❑New OAddition ❑Remodel OR ir �T.I. �i n �S �i�dcler ❑Demolition �Cha of Use <br /> DESCRIP710N OF WORK: 1�15�-a ��i n � (�w v�� �L�' �C(.��� J� ��� �e�'U <br /> �.�� -7- e1�e�-c,� s� ��,. <br /> ASSOCIATED BUILDING PERMIT# if licable: <br /> MECHANICAL.PERMITAPPLIC.ATIO�1. ` PLUMBINGPERMI�'APPLiCATION ' <br /> Typsofproje�.t: _Nsw_ Addn ,�Ilteratlon RePaf� '�YPeOf�� �ew ,_Addn �Iteratlon Repair <br /> HxWres Llst of Fbctur�a F�res Ust of Fbctures FJxtures tlst of Rxttmm�s Flxtures List of Hxiures <br /> AIC-Air Handli Units Heat Pu� Toilet Backflow Preve�ter InsiC�BI <br /> forced Atr stems Urdt Heet� Bathtub �1r1�� <br /> Gas Pi i Boiler Lavato ash Basin Drinki FcMmtain <br /> Water Heater R�ri �raticx� Shav� Floor Drain <br /> Gi�Fire ace Wood Stov� Kitchen�ink&Dis os� Gr�es 1'rap <br /> G�Fta e Duct�n Dishwssher oot brains <br /> Giothes D er Hooku s Qther, Goth�s Washer Nl�dical�as <br /> R e Hood Warter Heater Other: <br /> F_xhaust Fan Sink(�rrrie�/Bar/Mo etc. Oth�r: <br /> "SPRINKLER/SUPPRES510N SYST�M, :. <br /> Chemicel or Water Na.of Heads <br /> ACKNO WLEDGEMENT.•1 have reviewed fhis application and confiim the infamatron contained hereirr is true and correct Work done pursuant to this pertnit must comply wifh <br /> arrrent/ederal,state,and bca!law.The granfing of a pemvt only authorizes approved work and no deviations therefrom Devlatans must first be authorized in writirtg from the <br /> Building Ot6aalbefore being authorized under eny dreumstanoe.i am the owner,or f am auNnwized bythe ownerd this propertyto perform the wortcfarwhich appli�tiorr is made, <br /> arrd!oompfywith the SYate ContrectorsLaw 18.27RCWand296.200.4 WAC. <br /> City af Everett Olfiaa!Use Ony <br /> � <br /> ,,,,. PERMT# ��_ ��� <br /> Owns�/A zed Si�e . te �) <br /> ,�-"^ <br /> ��"� <br />