|
� �
<br /> PERMIT APPLICATION
<br /> BUILDINGIMECHANICAL/PLUiVIBINGISIGNISPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 Cedar St , Gveretl,WA 98201 425�257-8010 FAX 425-257-8857 www everettwa crg
<br /> � V
<br /> $IT ADDRESS� vnOVFR7Y7A%a PERMITM
<br /> �;'lD , , �a G?d 9 0�9 2i� �o D � �
<br /> LEGAL��r�rx ce�s!,�na-. c�r.���lat s��m�vs�on ________ _ . . _I ni r�,_ lanacn coDY o�lono�e9A�tlesv�pi o�)
<br /> OWNER V (! ►Y.rS /tS G�/A7101'Pr`�^e�F �.x. I'op�'Sf3`� '��y
<br /> �0�•ns: C/�' � Cl� f�. � . If'^_ �C�r��SI,�Ir'L�0 �j�l(i!/�4�. W1 -/W08
<br /> APPUCANT: O+.'+e� X Onrer'sP9"�'.1 _ _Ccn%,yr.h.� _ Cunvacte,sAqerl Ie�a�t�T�.�.����.�e.a�...,,. ,�, _,. ,.� .,.,.., �c.,..+ n..r+,...
<br /> CONTRACTOR ` ,\!N+(if �LN� }'�,C�' �,i� �NL Sa!el�c ar µ RTC�7. _�-� CdyBcs L�c M
<br /> Fa�rrss -JU/ J. �Y1 y J+. Jfl�� . WA. �/rJ��� v1,�rc,Finad L� . 7 Z• �" I�C7
<br /> TENANT BUSINESS NA1dE CONTACi FOR PERMIT �2 �K �d �� L��S�I�"°^� t
<br /> ��t-� I(GSSIF-� " a
<br /> o��-��.mri N2s 2va 2 �ss Ji�nKa'�JZCo� flaN�s,
<br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ 3DL� �o�S ,__ _ .
<br /> Fr�s!�rgUseofA�r�9rg . _ �CS�dGr+i,) _____. . HF.AiS0U12CE
<br /> PrcOosen Use c1��,�:.••9__ _KISi C�b.nti a� __ __ Ga�_ f�ec•,:: 1�' piner .
<br /> �utld�rg ly,e , S��gie Pamiiy _,_D�O�ca_7ownhcuse ��d�IF I am ly ._ . Cormercal
<br /> 1 nc cl w�ed New Addtl�on RemoAe� Repart T I S�C� __Sp•mklrr _ Demolbon _ Chan e of Use
<br /> D^E-�SC�RIPTIONOFWORKlaear,onaiscaceo'o���eoonmeDa.�l :�NG ��C�il;GshwC , ,1
<br /> ��-G�M7�C A-N' �ZE.I�IhLG : Slqin� , Ii1�Q��j . �.JI��C�ON t , S�aD f , L�CC�G
<br /> fUa tirr�s a.�D Zn;1� ,.bs
<br /> MECHANICAI. PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type ol Pro�ed _New_I10En _Allerahon_Rrpah Type ol Pio�rct _Nrw_Atltln Allrralion Prpav
<br /> Show NunrArr l�l nl6rlures Shew NumGrr(pl o!lufwet
<br /> NC-a�,ha�hna�:n Is I IOAcI
<br /> Fo�[ed a•r s clN�, �atFluh
<br /> Ga50� m Lavalo� washhacin
<br /> Wa�er healer ShoNcr
<br /> GBS(RC IT�p Ki!CPcn S�nk$d�c o5d!
<br /> Ci85 fdf1QP D�ST\A54P�
<br /> Cbthes d� �r UM�es wJSher
<br /> Ran e hooA � Wale�hralri
<br /> F.ham�lan � Smk �erncProm/mo Ir�c�
<br /> Ileal am llackl�,ow rrven!er
<br /> U�LI hPTlp� U�inal
<br /> BOiPf U�inFri hoi�ntam
<br /> Re1n pr,�lion Flocr tl�ain
<br /> 1N00(�SIOYP Grease tra
<br /> DuCLn � RoolA�a�ns
<br /> Other Me��cal Gas
<br /> SPRINKLER / SUPPRESSION SVSTEM omc�
<br /> I Numbcr ol Neads Other
<br /> 1r,•�rLrrrn!rPatlnarr�rr9n,nr.aa�.��reP�:a:c'�;atcnn-11ne.:,iqeeam✓�ocoiroea�a�n�e:1 Anp.ons.ome�Inwsa�.]vn��a�cn9ovem�.g�trshoeolwonw�oero�np
<br /> r'�y.h<IM1�`ISV'[ll�fd�f'fl�'.lin�'. i�PQr�n��nflflOfl���.1�1:�=!'flC'fiulP�Plp�.lA�.�I��n�'10\�'.��Pf.l(J^fYllnf�'O��r.q�11��\f�Yltll'p�SIJIC�I�!Hd�1.lNlCl�ul.l�N(�C(!n5�111C1�pn
<br /> 1�:11�dT�fl��1\1+Or�tf��Y I�c Cn1�Pr(I11'���'�`�Pr�y IJ�r'�.]�T�li�1��:��It`r n��ch YCfI�C.11!'n.�T�t�n Tn]I rcn�.Ply��+1�I�!�IJin Cf.nlrTt:(1'S lr.V 19)1()(.lY dn�:4�)p�A\1'hC
<br /> ' /Q11u._M �Gf�.� �0/77 ���/
<br /> Owu.�IA� honxeA Aqenl Si nature —�DT lRe;iopd 9'?Oi�l �/3
<br />
|