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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> a x CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everette..pSQ verattvia,gov 1 www everettwa.gov/permits <br /> Blue or„Black 1tk,Oi l a) O sI"r' &INpo , r <br /> PROJECT SITE ADDRESS: y IA); , <br /> , � �• etivoPROPERTY TAX#: <br /> i`ECAi:-for new construction: Short <br /> t Plafls�tivislon Lot No.` (attach copy of long legal description) <br /> , 3 .,,.. -. tri y �y �a r� <br /> ' - -`CONrAC'II'II$FORMAIIO1 ` n# 3'n fix. :' <br /> OWNER NAME a: r <br /> l: P ri # TENANT NAME i Commercial) <br /> OWNER MAILING,ADDRESS STREET J •( -�^ +' !K. '” <br /> 0 t.t� !._ 7w+ STATE set 0 o. <br /> OWNEitPHONE 5 1- ZP +` "� <br /> "!f OWNER MALI:_ <br /> CONTRACTOR NAME: .111 �:_sdt:,i In C <br /> i. <br /> coNT1 CTOR ADDRESS: <br /> srrtEEr 1 14 rip <br /> CITY a {. <br /> STATE /t ZIP "1`;s 0 I <br /> CONTRACTOR(( pPHONE; p ojp 0 CONTRACTOR EMAIL to ;` , wr if <br /> Co <br /> _...::.._.c'"{ oRt. l fisse Y'4 -Ili 8„1. ip. ......_. .. lid - 4 �°-4 : : - N -�r iN' I , <br /> PRIMARY CONTACT: ❑OWNER to`. fl <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> ?SACT NAME: CONTACT PHONE <br /> *25 255 <br /> CONTACT EMAIL: 16,,, 0 0 f <br /> ,.' 4..*ezBU1 t 1N E I'I1 ppLJ - ; N-4` <br /> Esistirfe Use of Bulletin*: <br /> Contract Price of Work.$ 7*.0- <br /> Pro*aaad Use of Building: <br /> Heat Source: Xeas 0Electrlc ❑Othe m <br /> Building Type: " R-Ooiett ❑SFR Attached <br /> Ctititiax Elfelttitllcartely kofUnits; ❑Commercial ❑Industrial <br /> T,peofpr4 t: DNew DAddition CDRemodel 0Re*air ❑T.I, CIS mn 0 ,rtrtkleir ❑Demolition OChen.eof.Use <br /> DESCRIPTION OF WORK: „ (j s (,�S"" ' <br /> ASSOCIATED BUILDING PERMIT# 4fa*'ilcable i' <br /> M 1".IN 11'. 1 I RMrrAP 1.1Cl TIQ(tt. =_ a- ` '. I:IIII�ll1I1! R941II> <br /> Type of Project New Addn Alteration Repair �� - ������� ~ <br /> *of - W �- p Type of Project _New �Addn Alteration _Repair <br /> �, :.:.. ,_,,_ *of #of #of <br /> � of-Fhtt fixtures LI Fixtures <br /> FOedHarling UnitsHeat Pump Toilet ;Backflow Preventer ares <br /> Air Systems <br /> � Unit Heater Bathtub - , <br /> nter{inside Bidg) <br /> �s Piping �. . Urinal <br /> Gas <br /> WatPitn Boder Lavatory(Wash Basin) a <br /> Rea, - hl Fountain <br /> ` � Shower' <br /> ( Gas E�rpl �`.> Wit t� � Floor L� in � <br /> Gas e l(ltetten Sink Dpi Grease Trap <br /> Clothee 0tictin Dishwasher <br /> > _H�ups, ',s:• Other- - _ MRedi fits` <br /> � = Clothes Washer ' • <br /> Range Hood Medical Gas <br /> afar Hsi <br /> a Fan Oche,:, <br /> _.. , erdsoff/ ' :., ;to. Outer, <br /> Sink.S = - , <br /> SPRINKLER I SUPPRE SION-SYST'EM <br /> (Chemical or Water ENo.of Heads <br /> .., <br /> "ACKNOWLEDGEMENT.:t have reviewed this application and confirm the Information contained herein Is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the .. <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform(he work for which application is made, <br /> and I comply with the State Contractors Law 18.27 ROW and 296.200A WAG. <br /> City of Everett Official Use Only <br /> '�.4i fPERM4 <br /> / . t51 , ' <br /> O r7Attt rsrl d Ail signattire it _ .%C3 ''� O `Q <br /> Date '. .( +aecr016} <br />