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i-iay vi cvi r i�,�yru•i vvaaimiyuni vvaiei nCa��S OVVJ/JIYJ`-F �JGt�.�l <br /> PERMIT APPLlCATiON <br /> BlltLDiNG!11tIECHANICAL i PLLIMBING /SIGN /SPRiNKLER I QEMQLfTlON <br /> CITY Dt=EVERETT pERtv717 SERV(CES <br /> 32�4 CErJA�STREET,EVERE7T,WA 98201 <br /> iFi=%�-<-�-R�1� ; �A}5425_257_g857 !fE}everetieps@eve�ett•�ra.gov� wvuw,everet#wa.govtperrr�its <br /> (Blue ar Black Ink OnEy P�$ase) FRQJECT StTE INFO�iMATItlN <br /> PROJECT S1TE ApDRESS: ! � ,� ,(r[ �n O PROPERTY T'AX#: ,3 �'G1�(j�(,�{� '�"''�f' <br /> LEGAL.forr�wConsiructlnn: Snn�P;a-:s�N;:�,s.,�., �_..._ <br /> - — �_.._......,.,., ..,,y��yo� ��w�N«��,i <br /> CONTACT lNFORMATiON <br /> OWN�R NAlNE: �' � � TENANT NAN{E(If Commerciai): <br /> OWNE�MAIl.ING ADDRESS: s;-e� � � �,(SIYZ(� <br /> -. ��'+ 21p � <br /> OWlVER pHONE: �WNER EN[A[1.: <br /> CpN7RAC7'ORNAME: {,�,,�H-,1r�t��G��GN r-?��iL ��.--�'TE-i� <br /> eorvT�ac�oa aoaRFss: �-_�_, ; �, , -- �G �G�C y�(;�j <br /> � �7 <br /> �'�' �l�{"�� S7AT= �r� 21P <br /> CpN'fRACYQR PHC�NE: '�'�Z`�'���" CONTRACTOR EMAiL: Y U C�b���..i ���i'l <br /> CC3NiTRACT�R LICE3�iS�+:;=c=�,^�::�K�G,; (,(,)�'7--�—�"�g� GITY OF£VERETT BUSINE55 LIGENSE#{REQUtR�D}: � ��� <br /> PRIMARY CONTACT: f`,�pyy�;�� CflN7RACTOR ❑OTHER(Please SpeCiiy} <br /> .. _-- �-7 - <br /> ---_. <br /> cot�rr�cT rv�+m�• COMTA�T PNOME: �'Z �' 3—[f�' l f <br /> `�""ti-` �(•L���� �,� COI4TAC7EMAiL: Lv1�ik/fJ'IYLI�.,����C.•C��y/ <br /> BUIi.DING P�RMIT APPLlCATIflN <br /> �xistin Use eF B::i:d'-�: l Contract PricB of Work: $ t <br /> Prooased l;s�oi 3:�-?d�n;; Fleat Source: ClEfectric ❑dther <br /> Bui(din Y 6E: QS�Fi-�2i�G`':ari nS�R-AtEarhad ❑puplox ❑Mufti Family#o#Unit�: ClCurrxnercial �Intlustn <br /> Typa c`P-o;�ec�: �N�w LAadifion URemodel C7Rapair l�T.l. OSi n ❑S r[nkler ❑Demolition �Change of Use <br /> DESCF21Pi'ION 0�WQRK: <br /> � �I��"-G.� l "' j�/�c-�- d AJL�Y �./� ` �C L'lS� 1..�Y' <br /> t� 'W <br /> ASSOCIATED BUILDING PERINiT�(ir acplicablel: <br /> MECHANIGAL.P�RM1T APPUCATiON PlUMBlNG PERMIT APpLlCATfON <br /> 7ype of Project: _New Addn �A(teration _,.,_Repair 7ype of Project: i,_,New �Addn Alteration _.i7epair <br /> iF ot r - <br /> Fixtures �'�sY of Fiz:ures ��u Es Lrst of Fixtures #of Lf5t of Fixtures �°f List of Fixtures <br /> Fixiures �ixtures <br /> A/C—Air Nandli�g U�its Hea,Pump Toilet Baekfiow Preventer(lnside Bidg) <br /> Forced Air Systems iJn�'Meater 8atht�b Urinal <br /> �as Piping 5oiler Lavatpry(Wash Baslr) i7rinking�ountain <br /> Wa#er Heater Reirigera�on Shower Floar l7rain <br /> Gas Fireplace Woc�d S�ow Kitchen Sink&Dispasaf Grease Trap <br /> Gas F2an e Dvcting flishwasfier Root Drains <br /> Clothes Dryer Hcokups Cther. Ci�thes Washer Nledicaf Gas <br /> Range Hood tNater Heater Qther. � <br /> Exhaust Fan Sink{ServicelBBr/Mop/etc_} Qther: <br /> �PRINKLER/SUPPRESSION SYSTEM <br /> Number af Heads <br /> ACKNOWLEDGEME/VT:1 have reviewed ihrs applrCation and confirm fhe rnformation co�tainad lreiein is true and carre:t Work done pursuant to this permit must comply wlth <br /> curr�nt federal,state,and local/aw. The granling of a permlt oniy aufhodzes approved work and no devialions thereffom.peviations mus:f�rsf 6e authorized rn�vriting bom the <br /> Building Of iclal before being autharzed under any tircumsfance.I am the owner,or f 8m 2uthoiized by the owfier of thia properly fo perfarm the woik for whrch zpplitation rs made, <br /> ana(ComF�Y wiBr the SfatA Rnntractnrr Law ti a.a7��tii d 20&.a00A 4�A1: <br /> Clty of�verett OHrcla!Use Cnly <br /> , /'��� PERMIT#y�n I�D � `�'l� <br /> `f i Y � <br /> r/Authorized Ac�ent Sign ture Date (Revrsed 5/20/20i6} <br />