|
Jun. 03 . 2016 10 :21 AM Plumbing Pros 3608296505 PAGE. 1/ 1
<br /> p (-:°- -(-- --- E. . r - 6 )
<br /> e(,04111b,zillii ;,:a BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 0200 CEDAR STREET, EVERETT,WA 08201
<br /> (P)425-2E7-8810 I FAX 425-257-8857 1(E)everettepscrw
<br /> Levorettwa,gov I ww,everettwa.gov/permits
<br /> Blue or Block Ink Onl .Altos. PKO,J* `l',SITO.il .. , „_
<br /> . NI�g1�NfIlA�'Np!w � m r..1►
<br /> PROJECT SITE ADDRESS: /T.570 G(C.sr /4 1 ROPI�RTY TAX :
<br /> LEGAI,.for new construction; Short Plat/subdlvlelon Lot NO. _ (attach copy of long legal description)
<br /> ONTACT INFORMATION
<br /> OWNER NAME; CMr„ �, ��� r / TENANT NAME(If Commercial): — Z -
<br /> OWNER MAILING ADDRESS: STAEETy /, / CaJ�.,J /U I 1� ) / cam/
<br /> CITY ,30-1 i U'Y- Cr STAT 6 Zip dee. //o
<br /> OWNER PHONE: OWNER EMAIL: '
<br /> CONTRACTOR NAME: t`3m,61 • ,rn S
<br /> K
<br /> CONTRACTOR ADDRESS: sTR eT 0,, 47 I
<br /> .-� CITY 81'ATE L .- •LIF' 1/ 3 1
<br /> CONTRACTOR PHONE S(fl0 - Z 9- s'5 5 L CONTRACTOR EMAIL: Ji • "A c.,.. ••e; 0/4,I 0771,11'h. /,
<br /> CONTRACTOR LICENSE#(REQUIRE=D): IF Offr7l '� CITY OF EVERETT BUSINESS LICENSE(#(REQUIRED): Yr,g II
<br /> .. .�... ' .... .,n«.. ...--.... ..,.,.i1,,.
<br /> PRIMARY CONTACT: 0 OWNER !' ONTRACTC)R 0 OTHER(Please Speolfy)
<br /> CONTACT NAME: CONTACT PHONE; '-' 61c),11"z ' . c
<br /> ,. U 1 "i 1 i-k l s— s `6-G.-�c____-e- CONTACT EMAIL: 1.) i r.,,//'N/. 4.) Mar CS
<br /> 1111. .;. .. . . .
<br /> r�i4I1 11'. .M IV -atEAPPL�Ie !QM
<br /> Existing Ueo of Building: Contract Price of Work: $�___�
<br /> Proposed Use of Building: - _ Heat Source: ❑Gas ❑Electric ❑Other___- _„�
<br /> 11111.22129„; I0Industrial
<br /> Type of Project: ❑New ❑Addition 0Remodel 1Rnpelr IT.I. C_ISlgn gSprlli er �7Damolltion I Change of Use
<br /> DESCRIPTION OF WORK: � �
<br /> ASSOCIATED BUILDING PERMIT# If a licc�bl®
<br /> M1 QH NIC�►h>,P�i1 MkIT APw CATI -, ••. . .'. ' _ ' L'MBINp, IT, APPLICATION
<br /> Type of prefect: Now _ Addn _Alteration ,Repalr Type of Project: Now Addn __Alteration _Repair
<br /> M of Lira of Fixluros of t.irti Of Fixtures Of List of Fixtures b 0/ Licit of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/ -Air Handlln$ Unite . Moat Runt. Toilet Backflow Preventerslnside Bld
<br /> Forced Air Systems Unit Heater _.._r.___Bathtub �l tins{
<br /> Gas PIS Boller Lavatory(Wash________7„._
<br /> thin prinking Fountain
<br /> Water Heater_ ReTiagari riowsr Floor Drin
<br /> Gas Fireplace ” Wood Stove Ktchan Sink&Dia•gsal ream Tra.
<br /> ' Gas Range _ Ducting Dishwasher Roo Drains
<br /> Clothes Dryer Hookups ,Other: Clothes Washer Medical Gas
<br /> Range Hood__ Water Heater Other, —
<br /> Exhaust FanSink(SerwlcoBar/Moplate,) Other:
<br /> SPRINKLER I SUPPRIIS$ION SYSTEiNl .
<br /> 'cumber o earls1. .1,.
<br /> .. .10... .�_.., .mmor.,a.arm
<br /> ACI(NOWLEDQEMENT::I have reviewed!his application and confirm the information contained herein Is true and conept. Work done pursuant to this palm/t must comply with
<br /> current federal,state,and local law, The granting of 4 permit only authorizes approved wails end no deviations therefrom,Deviations must flat be authotlzed In writlnq from the
<br /> Wilding Official before being authorized under any alroumatance.I am the owner;or I am authorized by the owner of thla property to perform the work tot which application is made,
<br /> and 1 comply with the State Contractors Law 18,27 RCW end 206,200A WAC.
<br /> City of await Official Use Only
<br /> Q. PERMIT* — r,
<br /> ,r�, /
<br /> •! /
<br /> � OGr
<br /> Ail./� .
<br /> . .,.:s ,/r
<br /> . . r Ut/
<br /> Owner • horizad Agent Slgnat a DEL a (:oviSod 6/20 • 6)
<br />
|