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PERMIT APPLICATION
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<br /> BUILDihiG/ f HANICAL/ PLUMBING I SIGN /SP_ ,-.KLER I DEMOLITION
<br /> "...1—. .. CITY OF EVERETT PERMIT SERVICES
<br /> 94
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<br /> 3200 CEDAR STREET,EVERETT,WA 98201 .., i'lLtP5tCAL I Ff)(4 '
<br /> • 144 61r
<br /> p)425-2.7-8818) 1 FAx 425-257-8851 I(E)everetteps@eyerettwagov'rwww.everefiwalov/Pen-nlIs
<br /> Blue Or SI „
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<br /> ''.'''.7 ',..;k 0111 fattittlk. PRO.'
<br /> PROJECT SITE ADDRESS: I 0012- ,..44-1,, AOSW. irIOI PROPERTY TAX#: 280q2:NOD 2 Of 9010
<br /> LEGAL for new oonstruction: bort Platieubdivision Lot No, ttech copy of long legal description)
<br /> OWNER NAME: BR EN l'f-tc,or) P4 0A71.1 1..Lc, TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREE t
<br /> Cil't STATE ZIP
<br /> .............,._
<br /> OWNER PHONE: OWNER EMAIL:
<br /> . ......._.
<br /> CONTRACTOR NAIVIE: Lo 1_, tACCI4Iitt.)1CAL j Irt C.
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<br /> CONTRACTOR ADDRESS: STREET 2 q 0 0 ktit,„ *ROO.* 5+ 41 284
<br /> • CITY ,Sem`r 7 LC' STATE (A)A ZIP 412 1
<br /> .............„,
<br /> CONTRACTOR PHONE: 70(0 .TTVI ab 2 01 CONTRACTOR EMAIL: bri4p `) r i 0 A eel-etwiloo4.61-4
<br /> CONTRACTOR LICENS7'.,..,,,.. .,,i....nikED): Lo IA L PAT IV rfA4,:, CITY OF EVERETT BUSINESS LICENSE#(1!EQ UIREDI:<344131 ")
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<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME; CONTACT PHONE: Utz, 5(0 3 ::7
<br /> E kukJe L ARso Ni
<br /> CONTACT EMAIL: icuri A A'D
<br /> -**----------- :.`:;.'..' ;'. • t•pooffiRT Applaciskispi2j.„-tri::: , `,..... \.,.-LA,, ..
<br /> Exislins Use of Building: ..,'"''''Tit Cs'A ' '. Y 'Contract Price of*irk:$ 3 OOO
<br /> , . DElectnc,
<br /> Pro,rosed Use of Building '1,..f.NA,C. Heat Source: uses - °Other,
<br /> • :........._—,
<br /> Buildin* T pe; OSER-Drrtacheri OSFRAtIaohed °Duplex t(Multi-Family-#of Units:_ 1 °Commercial °Industrial
<br /> T re of Proact: CiNcm °Ade,:on L3Remodei Q Re air OT.I, 0Si s n OSprinkler °Demolition °Charlie of Use
<br /> DESCRIPTION OF WORK: Re jpiA,Le. elvs„Tit,z,4 .t.L4s, m Avce esis,rt/46 ko.,4440_vo t.RAtii r.0 ce)vciz
<br /> Plvs74L,-.
<br /> IIEM ftweViS Wet Fi.A.t..66 4---T)LZ x.AA,
<br /> ASSOCIATED BUILDIIIG PEE-dill:TIT arkl,.. ble).•
<br /> MECHAKKAr. 71.tIMM,Ilr.„„iCISTION ''',11,',f;iii,7 PLOMBING‘PeRMItH,.... *PON
<br /> Type of Project New Addn Alteration Per g:Jr Type of Project: New Addn Alteration , Repair
<br /> #of 'f. fili. I a of #of
<br /> List of Fixtures i :1,0;1705 1 List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtures Fixtures Fixtures
<br /> A/C-Air Hancho Units f Heat Pump'
<br /> ; i Toilet
<br /> Backficrisf Preventer(Inside Bldg)
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<br /> Forced Airlysforrs t nil Heater t Bathtub Urinal
<br /> •..-r2-I-:: ( 'Lavatory(WaSh Basin) ' 'Drinking Fountain
<br /> :.!_o....„.„.,
<br /> Water Heato. 1.- rneratron Shower Floor Drain
<br /> \------"rGas Firepiate *4"-----r*N:o od Stove Kitchen Sink&Disposal Grease Trap
<br /> 0
<br /> Gas Range - ,,cliiic- iD shwasher Roof Drains
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<br /> Clothes Dryer Hookups 'Othet:
<br /> 2f2911-iood _ •
<br /> Water Heater , Other:
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<br /> Exhaust Fan Sink(Service/BariMonletc.1 Other:
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<br /> SPRINKLIEK,' ,ii0L1,-., , ;. ,.
<br /> Y.,..1241 Mk I.. posommommomon....... .
<br /> 4.'
<br /> ,,• ,twoitrn die
<br /> information contained herein is true end correct Work done pursuant to this permit must comply with
<br /> AcurCKNnfOfWariLeEraD/'GaEtaMieENri i-"'and lc- ' 7:i'/2'):iy authorizes approved work and no deviations therefrom.Deviations must first be authorized in writ,from the
<br /> Bure
<br /> iiding Official before hem:. . ., ..._. . . ...!i, 9..1 am the owner,or i am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the Si31;& ' —' ' ' ' — ", --,,,,520i)4 WAC.
<br /> City of Everett Official Use Only
<br /> PE411T.#-
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<br /> Owner/Authorized Agent 51;is .i.,It Date (Revis 510/2016)
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