|
PERMIT APPLICATION III
<br /> , ,�'" BUILDING/ MECHANICAL/.PLUMBING/SIGN /S, NKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 141111 '11117211-
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 j(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or.Bleck" nk On y eas ) �h.i; „ PROJECT SITE:.INPORNIATION "
<br /> I
<br /> PROJECT SITE ADDRESS: COGtTV 411e. PROPERTY TAX#: '17156 ZOOkXJ
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OWNER NAME: C4L.13V GRiL r 6753-L.LG. TENANT NAME(If Commercial): (JII L$I5 IIJI/1'1-$rM
<br /> OWNER MAILING ADDRESS: STREET /Q 1,0 kJ CASINO RD
<br /> CITY /fi:.tZrte- STATE IIJA' ZIP 9'$Z it/
<br /> OWNER PHONE: OWNER EMAIL:
<br /> n"9.�Tn.,�. T7,,,,,�. .�,nn, ,0,,,,,,,* mm--. . „� �n ���.,� .. aa ��N � ,.
<br /> CONTRACTOR NAME: UlJ I Sfl JLN Iii w*J
<br /> CONTRACTOR ADDRESS: STREET 210 Z. /ii4 /-t/ . ' /�
<br /> CITY Sr rri..r.-- STATE OVA ZIP tri3y _..
<br /> CONTRACTOR PHONE: Z06 6$'Z 7735 CONTRACTOR EMAIL: C'S@ Jir-S1rz 1AJ,1*$J.cam
<br /> CONTRACTOR LICENSE#(REQUIRED): IArg/�I t 7Q�E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):D.S�
<br /> J.Sr
<br /> PRIMARY CONTACT: t WNER CONTRACTOR ®.THER(Please Specify) �� � ��
<br /> CONTACT NAME: /r CONTACT PHONE: �6 614 77
<br /> G.) (�I1r t lq tS CONTACT EMAIL: 41411.4W...61-4-4.---.-+), s4
<br /> ,,,, -_.- '-'—'4"--m'B JIL-DINO PERMIT PE :IAT ONS ff x h n( a :
<br /> co
<br /> Existing Use of Building: Contract Price of Work:$ ���
<br /> Proposed Use of Building: Heat Source: El as lig lectric IMPther
<br /> Building Type: E1FR-Detached FR-Attached uplex rip ulti-Family-#of Units: fir, ommercial Edustrial
<br /> Type of Project: Er ew rit ddition EU emodel HU epair 0-.1. sbir F-1.• prinkler Hoemolition ill hange of Use ,,
<br /> DESCRIPTION OF WORK:
<br /> J1JS uL. 11L14$41Alk rr,.� (c.w) wALC.- 516,A2 hr c v ., 1.,°40"7 R IQ
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> I °i 1R�I
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC-Air Handlin. Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Pipin. Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refri•eration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Ran.e Ducting Dishwasher Roof Drains
<br /> Clothes D er Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:_
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> ,� ,S,PRINKLERISUPPRESSION SYSTEIVIi,i�,
<br /> Chemical or Water No.of 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 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 I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I compl with the S-to Contractors Law 18.27 RCW and 296.200A WAC.
<br /> r. r
<br /> ,0
<br /> City of Everett Official Use Only
<br /> L ZCI,� - PERMIT# 1 N°1�On
<br /> itl)C, `✓j
<br /> L
<br /> O • Aut orized Agent Signature Dat (Revised 9/23/2016)
<br /> N
<br /> /7-/ ;
<br />
|