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<br /> PE-lin/0-r APPLICATION
<br /> BUILDIIN—MVIECHANICAL f PLUIVIBING /SIG\ :RINKLER/ DEMOLITION
<br /> ,41.44 CITY or EVERETT PERMIT,SER
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<br /> 3200 CEDARSTREET,EVERETT,WA 98201
<br /> (P)425-257-8810 .1-FAX 428;257-8857 I(E),eVeretteps@everettwa.gov I www.eVerettwa.gov/perrriits
<br /> :01400(.0.7E$1,11g J.NPORMAY0:04,,„,,,..,,:i-z,...,:„,,,,,,,:,..i.'„,;,,'„,-,„,..;1:,,,,„,..:,,,,..,-,..:: :-:::.,..,-,,'',•:...:•::' :-';::‘
<br /> PROJECT SITE ADDRESS: - PROPERTY TAX#: ,
<br /> ;/Al( tr' ;VE -va?Fi7 ' - 9)9,10 f 79 0517 4x 9.210 00 z/
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: E 1.i 4 A b.-77- Noas604. , /143 7y c-/ TENANT NAME(If Commercial):like /
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<br /> GINNER IVIAILING ADDRESS: STREET S CP 17
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<br /> CITY 5 1/58 6;17 STATE 4?....."/1 ZP 99 2©/
<br /> OWNER PHONE: 15- 2-3 te OWNER EMAIL: X*670 Y.*g EV/44-4!)( 67
<br /> CONTRACTOR NAME: AA,L.l 4....-7 - c 9 fv,s---?dc TctsiA 6-tyf--7. "-CONTRACTOR ADDRESS:ADDRESS: STREET 31 26) _pie4 ,,e4/77.- /546425:
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<br /> ori STATE Fe/ i'74--/`,./ STATE a....."(ig zip 9/19 g)/
<br /> CONTRACTOR PHONE; g2,„5 - 26-.9-6 ar>"" P' CONTRACTOR EMAIL: gp.63",--21..4 €;?.., ,,,,,,,,,,,--„„,„..,,,Ater
<br /> CONTRACTOR LICENSE If(RE9UIRE13); Cc AA Z.i3OP ir ciTy.oP EVERETT BUSINESS LICENSg.il(REQUIRED): 03 /.9 22
<br /> PRIMARY CONTACT: Er)WNER 9 CONTRACTOR CI OTHER(Please Specify)
<br /> CONTACT NAME: •
<br /> e-L) ( -1/114 C' CONTACT PHONE:
<br /> CONTACT EMAIL: )iffidij(67. - EV'g4. . 01-Cf-
<br /> ':''''.."..11.,,.' ..,...----_7,--......,.'_.',..7.'''''..::,' -,',-`''',::::7::::1-:::.`;',:::i:...0111.114:1010.0 00-0719i.t.i1.7;001:1d6t,10,147:';'..:''''...:::„.`:I.:71;. '-::,l'.t.'":: --_-•.-::',;:',::::;;;;-::-;,:...:•]..!:.-..7.. .,: ', .--.
<br /> •Existing Use of Building: 5Z,)/c9atic91/514-4,4 4:1P417-40.65- Contract.Price of Work:$
<br /> Proposed Use of Building: #47/9A7,0-75..trs Heat Source: EJGas ffiErectric 1210ther.
<br /> Building Type: CISFR-Detached EISFR-Attached EIDuplex, I __ffiViulti-Family-#of Unite: 5-6) •--'="-,otnmercial Et Industrial
<br /> Type of Project: 1:iNew. ElAcIdition aRerriodel• BRepair Intl. D.Sign ElSprinkler EIDemolition IDChange of Use
<br /> _
<br /> DESCRIPTION OF WORK: e\ Floc_ A.)0, s-7-.R ti cr ud:14..z.„. — 7 7,/i- 419,,t----, lig
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<br /> ,catz ).sirs
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<br /> ASSOCIATED BUILDINO PERMIT It(if applicable):
<br /> 01140, AISICCAli:„PtOOKIT7,APP414g..00Nf:.'_!:::-:•:. .';::: .:':,:;,:::::::..',1::,..101;70M13%:00PtOletrAktkiditil0,R.,:<1;i'1•:'.7':'':::'''.',.'
<br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration __Repair
<br /> #of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures #af Foctures List of Fixtures
<br /> Fixtures' Fixtures- Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet
<br /> Ba
<br /> Forced Air Systems Unit Heater Bathtub Urinalricnkiow Preventer(Inside Bldg)
<br /> Urinal
<br /> Gas Piping Boiler ' Lavatory(Wash Basin) Drinking.Fountain
<br /> Water Heater Refrigeration Shower _ „ Floor Drain
<br /> ,_ Gas Fireplace Wood Stove Kitchen SinkA Disposal Grease Trap
<br /> Gas Range Ducting Diehvvasher, Roof Praills
<br /> Clothes Dryer Hookups 'Other: Clothes Washer Medical Gas
<br /> ..,
<br /> Range HoodWater Heater Other;
<br /> .
<br /> Exhaust Fan _ Sink(Service/BariiVlopletO.) Other:,
<br /> $01IttitcPtifksX470egiggi.00:::$:01:40/G.',74-::::.,
<br /> Number of Heads - - '
<br /> ACKnavvLEDGEmENT:(have reviewed this application and confirm the informationzontained herein is true and coned.Work done pursuant to this pennit must comply with
<br /> ontrent federal,state,and local lam The granting of a permit only authorizes approved work and 710 deviations Therefrom Deviations must#rst be authorized in writing from The
<br /> Building Official before being authorized under any circumstancei am the owner,or I am authorized by the owner of this pipperty to perform the work for which application is made,
<br /> and!comply with The State Contractors Law 18,27 RCW and 206.200A WAC.
<br /> City of Evelett Official Use Only
<br /> ,..............-
<br /> PERMIT/A
<br /> ,,i. ,,'
<br /> •j... I/204 s()b-7
<br /> Owner/Authorized Agent Signature D te aRevised it:/1 20/5) ----N\"
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