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<br /> PERMIT APPLICATI
<br /> , .--- BUILDIIIIIIIRECHANICAL i PLUMBING I SIGhrrSPRINKLER i DEMOLITION
<br /> 444.411 CITY OF EVERETT PERMIT SERVICES
<br /> • 3200 CEDAR STREET,EVERETT,W 98201
<br /> (P)425-25T-8810 l FAX,428-287-8887 I tE)everotepsitteverettwa.gov I isvmetterettwa,goviperrnite , , .
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<br /> PROJECT SITE ADDRESS;, , 514 3- 5 rt))(nu- ' . PROfteRTY TAX.#: '
<br /> LEGAL for new consirtiotiort Short Plat/subdivision . , , , , ,,, , .1.ct144. (attach copy otIong legal descron)
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<br /> OWNER NAME: (A/V Vk '. ' ..0 # f T TENANT NAME Of costinarcia1);
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<br /> WN'''ER N'-'A' L.''ING A.'iDD''RESS^ S',T,4„iR,21E',E6T
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<br /> OWNER PHONE 1_ NER
<br /> CONTRACTORMAME: 11(z) 4 - 14 - )4
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<br /> CONTRACTOR ADDRESS: . , - ,
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<br /> CONTRACTOR,PHONELl?,5 —335 460).i:1 CONTRACTOR EMAIL rtof46 esorvt,
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<br /> CONTRACTOR LICENSE IRREDUIREOP trpr 0 ha 4 ic-tilt4ITV OF EVERETT 13USINE.SS ucatisE somoutHEDi 4?--74-1
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<br /> PHiosArtv coriTAcT: 0 OWNER Or;DONTRACTOR 0 OTHER(Please Specify) • , .
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<br /> CONTACT„i hFa'ri?t
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<br /> xistino Use of Building: , , , • Contract-Price ofIlifork-$
<br /> 00119.90 Use of Buildirig: Heat Source: rats Veiscste gOther
<br /> puilding Type:, cl-FR-Detached IPSFR-Attached ,ritlupli‘ , MUltl-Family#of Units: ,POontrnercial, Pindustnal
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<br /> Type of Project ONeW 13Achlition ciReniodel, pi4pair, CITA. OSign CiSprinkler 130entolition •ElCharge of Use
<br /> DESCRIPTION OF WORK: ‘ - .... a _. ...I-- /1:2 te 0,11 ,1,44.7)a
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<br /> ASSOCIATED BUILDING PERMIT#cif applipuble):
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<br /> Type of Project _Neer Addn Altatathin ...ikepair Type ofProject: New Addn _Alteration Repair
<br /> List c.f?adores - ,• LiatoffixtUres 'List of Phatires List*Mama
<br /> Philtres antlres • ums . FbrturPs ,
<br /> NO-Air NendliogVilite , 1 „fiegit Pump FAl , .,Toilet • . , Backflow Preventerlins*e1d9)
<br /> Forced Air Systems - ,Unit Heater ' bathtub Urinal
<br /> Gas Piping , 78c110 ' ' '' ' 440tOry."01eisti Stein) ' Drinidng Fountain
<br /> Water Heater Refrigeration • • `Show Floor Drain
<br /> Gas,FirePlace • • %Nowt Stove , • Kitchen Sink&DispOsal -Grease Trap
<br /> Gas-Range -. • 04dt* ' ''Oteherasher Roof Drains •
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<br /> Clothes Dryer Hookups Other . _ ' 'Clothes Washer , Medical Gas
<br /> Range Hood Water Heater: ' - -- ' Other
<br /> Exhaust Fan Salk(Servrce/f3ar/MOPletC.). Other.
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<br /> Chemical or Water J iNo.of Heads
<br /> ACKY,OWLEDGEMENT:r how reviewed this application and confrinr,the:Intormation contained twain:0 true•andoOrrect,Workt,fonepurstrent to this pennit MUST COMOy MO)
<br /> currant federal,state,and local law The granting 01 a permit orrly al.ithorkasApproved wOrk and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building otroetbefoie beingauthertred anderany circumstance.I aratire,ownen or I am authortzedlptheoWnerot this property to perform the madam which application is 7t7EICAP
<br /> 1 and I comply with the State Contractors Law 1817 PCWand 298.2004 WAG.
<br /> City of Everett,Otlicial Use Only
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<br /> OwiteriAutliorized Agent Signature — Date '(Revised 9/23,02018)
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