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PIWIlill APPLICATION
<br /> BUILD11'.NVIECHANIGAL I PLUIIIBING lSKGI7 • PRINKLER./ DEMOLITION
<br /> CITY OF EVERETTPERMIT SERV J
<br /> 3' ` 32OO;CEDAR STREET,EVERETT,WA 98201,
<br /> (P)425-257 8810 I.FAX;425-2578$57 1(E)everetteps@everettwa:gav I www:everettwa-gov/permits
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<br /> PROJECT SITE ADDRESS: .._ PROPERTY TAX#:
<br /> t 2.3 R/4/AJ/044. .4✓G` ,Eui-V/ ?1,41 97o, I: a90J(7e2o a r)f oc2"
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. . . (attach copy of:long legal description)
<br /> _ ... .;.r .. Clalgit GtiT tilt0ORl1 11.1 EA1? .ff. . . . . .. . } . '2.'-.....:'::'.'::'.:;:::-.:',`..'" . .,.
<br /> OWNER NAME: It TI'' ' FG+Sf,J ,c(� ffrJ�rT TEN NT NAME(If Commercial}:` 1A L 144,taJ
<br /> OWNER MAILING ADDRESS: STREET S_/C Gc9, )4t
<br /> cnY,. 5 V ".7/ STATE 4(.-A/7 ZIP 2,g2 0/
<br /> OWNER PHONE: t P..) 2-3 } -90/6- OWNER EMAIL" ) V g EV/14-,Core-'''
<br /> CONTRACTOR NAME; /9-A,1-./ P C`r9.n S 7e/ 'i li,.9 AS"..;,-.6)C/41-7.-/-F.,5% ,.;L(t..PC--
<br /> CONTRACTOR ADDRESS:
<br /> STREET 3 ate: e / -<.1f-
<br /> art , c. r ,�Y/ STATE S ZIP l2 69
<br /> CONTRACTOR PHONE:; £Z1 0 2. --6pU 7 . CONTRACTOR EMAIL: j?D Ozi,....4/..4 0 /44/0Wc ,05TRuci'rrtJ,,v,-r
<br /> CONTRACTOR LICENSE#(RE9JIRED): C ./9-,SLI ECA pof>3 7 r CITY OF EVERETR BUSINESS LICENSE#(REQUIRED): (' b oZ 2.---
<br /> PRIMARY
<br /> PRIMARY CONTACT: IfrOWNER 0 CONTRACTOR: 0"OTHER,(Please Specify) .
<br /> CONTACT NAME: • CONTACT PHONE:, Lf 1z'g:?/6
<br /> ' t L 40 ! / A . CONTACT EMAIL111.:t011 pEti//. - r.?
<br /> .f sulr;,O1JNC'OtitilaliI1 APP.lI ideitiol�1 _. .. .-.. , _ _.
<br /> Existing Use of Building:, SE,A.)1(91? Hotic/ ) 4,19411;19,51;-.:Contract Price of.Work:$_________2_9/
<br /> Proposed Use of Building ,,47Y-, 7.24,lr 'r-a Heat Source: LIGas: LLFElectric ❑Other
<br /> Building Type: CISFR-Detached DSFR-Attached CiDuple t :i tilti-Family-#of;Units: SCS rrimercial ['industrial
<br /> Type of Project: ['New ['Addition CiRemodel j epair` QTI. DSign ©Sprinkler 13 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: `l�r C� "t�.a'G _ t�3 c 6-7,-,-; a c ur &. 7 4 cs,, 4'
<br /> -1* 14 finis. !f'
<br /> ,ASSOCIATED BUILDINGi,PERMIT#(if applicable):
<br /> MECHANICAL`•,PER'ilY!IT AP?Li+ liftkr PCii1 1lBING PEttki1PT 1PiIiLICATION : ;•
<br /> Type of Project: _New — Addn Alteration Repair Type of Project: New ,-„_Addn Alteration ,,;,Repair
<br /> it of #of #of 0 o
<br /> List of Fixtures List of Fixtures , -, flet of Fixtures List of" Fixtures
<br /> FF3xtures FIXtures Fixtures Fortunes
<br /> A/C-Air Handling Units: Heat Primp Tenet: Backilow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater, Bathtub Urinal
<br /> Gas Piping Boiler Lavatory"(Wash Basin) Prinking Fountain
<br /> Water Heater Refrigeration Shower. Floor Drain
<br /> Gas Fireplace! Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roofbrains
<br /> Clothes Dryer Hookups ' , Other Clothes Washer Medical Gas
<br /> Range HoodWater Heater. Other
<br /> Exhaust Fan Sink(Sewing&Bar/iVlopieto.); Other:
<br /> SPRINKLER,1„S,ffigitigSSiOYI S'1t'ST 91,:;,,:,. ..
<br /> Number o Heads
<br /> ACKNOWLEDGEMENT:I 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 grantirng of a permit only authorizes approved work and no deviations therefrom Deviationsmust first be authorized;in writing from the:
<br /> Sul/cling Official before tieing authorized under any circumstance.1 em the owner-or.I OM authorized h$the:owner of:this propei(y to perform:the work for which application is made,
<br /> and 1 comply will?the State Contractors Law 18.27 RCINand 296.200A WAC'
<br /> e (....,,,i,,, ,;. - City of Everett Official Use Only
<br /> // L7 / 6 PERMIT D 0 0.34/
<br /> ov%rrer/Ailthorized:Agent Signature (Revised 10/12/2015)
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