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<br /> PERMIT APPLICATION
<br /> BUILDING/MECHANICAL I PLUMBING /SIGN I SPRINKLER I DEMOLMON
<br /> CITY OF EVERETT FERMiT SERVICES
<br /> 3200 CEDAR STREET,EVERETT.WA 982O'
<br /> (P)425-257-8810 I FAX 42545743857 I(E)evereteps@eve,rethva.gcv,. wwvi.everettwa,goviperrnitS
<br /> Mine or Mack Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS:Y612.13' 6,:tAdA I4 vie . eve-Aerr tOof 9g.2.0 3 IPROPERTY TAX#:0064 S-5704.300,:i'0,..t 1
<br /> LEGAL fo,r ew ccnszructicr: SO i Plataktodrvision Lot No. (attach copy of iorgtergal dascnotOr.)
<br /> i
<br /> CONTACT INFORMATION
<br /> OWNER NAME:2—k Erzcy ti,t cc r S TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sr4L...=1-1-- 4/6',22 611;4A ‘L A ic
<br /> - ‘
<br /> Off', EVEI.E,T7- sTA75 .),..7 A z9' 9 8 az 3
<br /> OWNER PHONE: ya6--f579- y,6(.,L—, OWNER EMAIL:
<br /> CONTRACTOR NAME 4 616g,idArj smk, EiorEa...p.p...iiEs , rek.V..,•
<br /> CONTRACTOR ADDRESS: s",s.1"- s2i/o/. 3 ) 2.. c A 2 L
<br /> 7...---
<br /> CONTRACTOR PHONE: 47/A 6 0: - TO - f CONTRACTOR EMAIL: ..A i.litlie-, At ' .A .\ rA" ' A.,...t •.1••' **
<br /> CONTRACTOR LICENSE#(REOUIRED):AM Eik Z5e$7/Pig. 'CITY OF EVERETT BUSINESS UCENSE#IREOUIRED).;0551(o)
<br /> PRIMARY CONTACT: Hat-GA*4ER CoikomoR 0 OTHER Pease Specify)
<br /> CONTACT NAME: CONTACT PHONE: (2_,.5 5/08 AnGo te
<br /> AY ,e,"A P-Z 1,0"i
<br /> CONTACT EMAIL 5ifs A.A,
<br /> BUILDING PERMIT APPLICATION
<br /> Exist' . Use of Builcin : Contract Price of Work:$ 16f-r• co
<br /> Proposed Use of Builtii ,: Haat Source OGas C3 ffiectric DOther
<br /> ...............—
<br /> Build!. . Type: OSFR-Detached OSFR-Attached °Duplex Ohluit.farnii -4 of Units: 0Commenclai Clincusv-re.
<br /> Type of Protect: New OAdditon ORemodel ORepair 0 T,I. CiSign °Sprinkler °Demolition °Change of Use
<br /> DESCRIPTION OF WORK
<br /> 6-.Hos..t.)e,, ,,
<br /> ASSOCIATED BUILDING PERMIT#(if ap iblei:
<br /> ....
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> i
<br /> Type
<br /> s Project New Addn Alteration Repair Type of Proles:: New Addn ,c„.Alterstion Repel,'
<br /> #of #of ' #of 1 *of 1
<br /> List of Fixtures ' List of Fixtures List of Fixtures List of Fa-tures
<br /> Fixtures Fixtures i gixtures Fixtures '
<br /> 'Ale-Air Handling Units Heat Pump iTcl;er. •Backflow Preverster(Inside Bkdo)
<br /> Forced Air SySternS Un:rt Heater !Bathtub Urinal
<br /> Gas Fioin! Boiler Lavatory(Wash Basin) Dnriking Fountain
<br /> 1Water Heater Refrigeration ' f Sower Floor Drain
<br /> !Gas Fireplace Wood Stove Iktohen Sink&Dispose! Grease Trap "
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Cloth Dryer Hookups Other: Cothes Washer Medic:**Gas
<br /> tRange H CaX:
<br /> Water Heater Other.
<br /> Ex.",:aust Far
<br /> Sfnk(ServiceiBar/Mop/etc, Other:
<br /> SPRINKLER I SUPPRESSION SYSTEM
<br /> [Chemical or Water I 1No.of Heads
<br /> ACKNOWLED-GEML-Wr.I lave reviewed this application and oonfirm me irt.cormetc,7 coniserao henften is true Oral=erect Won(done pursuant to this peered must co ,Wtth
<br /> oterezrt federal.,stale,anp,dr,ei few.The panting of a perrn:1 only authorizes approved wo,*and no claulaPons therefrom.Devistor4S must first be authorized in ve-gtv from the
<br /> SuRding Offs:*Oefcreosing ort4,--0 tinder any orm,ornsterice I am the owner,or i am authiorized by the owner of ttris proseiy to perform the worx for which 400eat,o4 is made.
<br /> ane I comp/with the&ete Oortectois Law 15.27 TiCsiti end 296,200.4 WAC,
<br /> City of Everett Cir/a/Use aly
<br /> 1 FR.I.,,lIT
<br /> _be . , 75
<br /> .........._____
<br /> 0.„.3,1 c„i,...s,Agen Signature Date (Pe v?sed 9/291201•
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