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Otri" PERMIT APPLICATION
<br /> BUILDING I MECHANICAL/PLUMBING I SIGN/SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(5)evarettoos§everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink'Only Please) ' 'PROJECT4ITEIINFolk10010/4'Trm127--f:r'••;,,'. ','"'"–"'"."------"Tr---"'"----'—"--"------"'"----1
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<br /> PROJECT SITE ADDRESS: .......1 .2 rh.ja2.... ' PROPERTY TAX#:
<br /> LEGAL for new construction. Short')'3LISUbIlv:a.'h.1,1 Lo't ND. alliattacn copy of long legal description)
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<br /> CONTA,CtINFORIMAtiON
<br /> OWNER NAME ji. A . TENANT NAME(If Commercial);
<br /> OWNER MAILING ADDRESS 3-RFE- afb 410 t 1 * '4, '
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<br /> 3TATE krAdA ?JP .
<br /> OWNER PHONE .,, sr' ''' ,,, lib 0 OWNER EMAIL
<br /> CONTRACTOR NAME: "10 11 1.11C.
<br /> CONTRACTOR ADDRESS: STREr 14 rociztwaN
<br /> CITY ... . ‘4,..t .
<br /> s rAm. A zip 4ilf : 11111 I
<br /> CONTRACTOR PHONE: 2Fjct 0 0 CONTRACTOR EMAIL ,... 4 kf al ,IA .• it, a ne . 10
<br /> -- coNTRAG-ToR-LIG€Nse#9{5.9u;RE-0), teq., a.- a TY-012-EVEREITSUSINESS-UCENSE/ItREOWREDL -4 0-(27C?gr
<br /> PRIMARY CONTACT: 0 OWNER lYCONTRACTOR 0 OTHER(Please Specify)
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<br /> CONTACT NAME:
<br /> CONTACT PHONE: 4-2s 2.5 ci 0550
<br /> Valcoo UL
<br /> CONTACT EMAIL: a A a • keakt, 0 •co
<br /> , .,,,'4 -,-‘ - , ,,'AluiLDINGYAERIVI I',iikeStriCATIttiWM'%•" -i‘'IIPP41'•'1.'''' ''. ' '
<br /> Existin. Use of Buildln :
<br /> Contract Price of Work:S — a a . .. _.....
<br /> Proposed Use of Buildin,•
<br /> Hest Source: gess EfElectrIc 00ther
<br /> Building Type: eSPR-Detecmed OSFR-Atteohel °Duplex.- 0Multi-Family4of Units ElCommeroial Olndustrial
<br /> Type of P.'oje--...t: 0 New 0Ailltion OR3mocf31 DReolir DLL 03ign 03onnkler 0Demolition 0Change of Use
<br /> DESCRIPTION OF WORK:
<br /> \,Y\ k-(WL \r\et3 Pfkrni)f CV ile . tan& gas i----u.ex)cioL.
<br /> ASSOCIATED BUILDING PERMIT# if applicable):
<br /> IVIECHANICAL,A3EIRMIT AppucArtoht , „,,'0- ,', -,' --'1,.,:',4*LtimBiNdr-*ERWit,VAPPLicknoN
<br /> Type or Project; _New Addn Alteration Repair Type of Project: New Addn AlteratIon Repair
<br /> #of #of #of
<br /> #of
<br /> — lirit.,riervs- ik-Turas - cr.fei-, Llet-efigixturee-
<br /> Fixtures Lof Fhltrres------- •
<br /> 1111.11AIC–Air Haridlin Units 11111111......___ Toilet
<br /> Beddow Preventer Inside Bldg)
<br /> 1111111Forced Air Systems allimmurmegen
<br /> Bathtub Urinal
<br /> Boiler Lavatory(Wash Basin) Orinkin. Fountain
<br /> IIIIIIIIIEMIEMMIMIMIIIIIIIIIIIIIII Refrigeration Shower Floor Drain
<br /> 111111.11111111111111111 Wood Stove Kitchen Sink&Dis•osal Grease Tra«
<br /> 1111.1111=n11.1111111101.11111111 Ducting
<br /> Dishwasher
<br /> Roof Drains
<br /> MIN Clothes Dryer Hookups 111111110ther:
<br /> Clothes Washer
<br /> Medical Gas
<br /> MIN Ran iie Hoed
<br /> Water Heater Other:
<br /> aniallillimummummennimm....mi......_01.011111111111111M ,....maiumaimmainiummumm
<br /> Sink Service/Bar/Mop/etc. Other:
<br /> SPitINKLER1 SUPPRESSION-SYSTEM
<br /> allChemical or Water NMI No.of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this appdcation end 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 permitonly authorizes approved work and no deviations therefrom,Deviations must first Le authorized in voting from the
<br /> Building Official before being authorized under any circumstancei am the owner,cr I am authorized by the owner of this property to perform the Work for which application is made,
<br /> end I comply with the State Contractors Law 18.27 RCW and 290.200A WA C,
<br /> City of Everett Official Use Only
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<br /> PER IT ,. A ' * IP
<br /> ,.,, illt i g IDC(1 .-- ô (0
<br /> Ow,(Ir./Authorized Age Signature
<br /> Cate
<br /> ° (Revised E/23/2074)
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