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I, PERMIT APPLICATION
<br /> ' BUILDING I MECHANICAL/PLUMBING i SIGN.i SPRINKLER/DEMOLITION
<br /> a r r,,. CITY OF EVERETTPERMIT SERVICES
<br /> 8200 CEDAR STREET,.EVERETT,WA 98201'
<br /> "(..P,425-257-881p j FAX 425.2518851 (5)e�ttepst everatl gov I wawa evereftwa govtpe>`tnrts
<br /> PROJECT SITE ADDRESS: 5'L �< : - PROPERTYT -#
<br /> LEGAL for noomnsaucticer Short Pier/subdivision Lett N . 'Watt copy of torrg legal description};
<br /> < ",i E,;. :00,0 At*,'M . 4 ! Pte .,
<br /> 1 tTMOWNER NAM ` "YNf Comm rcral):
<br /> OWNER MAILING AbI)RESS: sm a'r
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<br /> CITY t :'i:d STATE to ZIF
<br /> OWNER PHONE 1j\. l.,,,4}(70,, OWNER ENALL;141fi
<br /> CONTRACTOR d{ 1 $`
<br /> CONTRACT0R.ADDRESS stager 'Mbtt k a t . •
<br /> ow stATE �:
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<br /> CQNCONTRACTOR
<br /> O T,F�C yam_PHONE' MliAlNTF ACTOR; N if,x. , ' �` n' .• i':`!
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<br /> CONTRACTOR LICENSE�EOulRED) a '01,0111$4rC `f iS IE v, t2E.Tr BUSINESS LICENSE'AREGtt.rtRE' °
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<br /> PRIMARY CONTACT: ©OWNER *CONTRACTOR CONTRACT ©4THER.(Please Specify),:
<br /> `pc/WACT NAi -CQNTA T PHONE °' ‘).'
<br /> VI '', : OXVI4i CONTACT AIL: IAS 6< fi� I . A
<br /> ,. -- � +`.,� ■■ '!�5 rip -
<br /> E7xliting use.of Builds Conte Price ct '
<br /> Proposed Use of Building: Heat Source: OGae DElectric 1 ttper,
<br /> Building Type: DSFR 1Oetached FR-Attached C=puptex , ❑Mini-Farnily4 of Units: I tomrtterr ial l Industrial
<br /> Type.of Protect; ©New ©Additionernode ©Repair E!T,I. 13Sign ©Sprinkler ;ElDemajition DChangp of Use
<br /> DESCRIPTION TWORT o '
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<br /> E,• .,. v<t.! /'ER **,0 LICA�"1 *le ',g40-1 * lF ! Ot 1AP09 A r
<br /> Type of,Pkotect _New._, Addnt _Alteration„__,Kepis&r. Type-of Project New Addn ltoratton: Repair
<br /> #or #of ,#of #of
<br /> i sE:dt towes t.rst'o(F xture5 L stof f, iftwe List of R tures
<br /> Fixturesxtrrros FdxtureS Flxtrrres
<br /> NC-Air Har dling Units- HeatPttnrp Toilet Backflow Preventer(tissiite Bldg)
<br /> Forted Air Systems Unit Heater I:. Balit ,Urinal
<br /> - ,Gas Piping Bose, Lavatory(Wash:Basin) Dri iking Fountain
<br /> Water Heater Re ration Shower Floor Drain
<br /> Gas Fireplace Wood Stove ICAohen Sink&Rifat; s Grease Trap
<br /> Gas Range: Ducting Pisksher f Brains _,.
<br /> Clothes Dryer Hookups erl, lettles Washer' Mei l,Gas
<br /> RangeHooil
<br /> _ Water Hter Other:
<br /> Mist" an Sink(Senricet art�plete: Other:
<br /> t chemical or Water I No:of Heads
<br /> ACKNOWLEDGEhgWr.l have reviaaed this.an ficatioa'and.Confrnr the irforrr atrdrlr cdnfainedper'eiu-°etrtre and correctWO*rkm la pursuant to this•peri d must compiywrttt
<br /> ounent federal.-stele,and fecal lam The granting of'a permit#niy authartzes approved work and no deviations Therefrom DerWaVoristriostesr be auttrorized in Writing from the
<br /> Btrl ling Official before berngauthonaed under any cir rmstance.I,eintne owner orf;amaathontzed by the owneruf`thslet`Perfonn the work ter which ePOriocikm is made,
<br /> and,I comply with-rhe State Contractors Law/827 ROW and 29a2191414 WAC
<br /> City ofErerett( iaf(.lae Only'
<br /> l � , 13:a,` X03
<br /> OnrsterilAu�ton ie Agent S4n ature }ate: • (Rerised 9 4/2016,).
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