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#111IPPPERMIT APPLICATION <br /> BUILDING / MECHANICAL/PLUMBING/SIGN/SPRINKLER 1 DEMOLITION <br /> q0 <br /> CITY OF EVERETT PERMIT SERVICES <br /> pli . <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8310 I FAX 425-257-8857 I(E)averetteps@everaftWaigpe I www.everattwa.gowloarrrits _ <br /> (Blue or'Black Ink Only Pleas ) <br /> PROJECT SITE ADDRESS: 1-ianre_R,_tks.2z: <br /> PROPERTY TAX ft: <br /> LEGAL for new conerwition: Short PlatIsubdiq,,i,thl (attach copy of long legal description) <br /> CONTACTINFORMATION <br /> arm••••••rnr.vesurammessz....‘ <br /> OWNER NAME: 20 P1 cict -` <br /> TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS, =1-4LET 4Q. <br /> C , gazni: <br /> ....._ 17,, OAL A' IOW <br /> srAr._ ,P <br /> OWNER PHONE: „„ 0 (6•10 OWNER EMAIL: <br /> CONTRACTOR NAME: . i n-- <br /> CONTRACTOR ADDRESS: grE-T' 1(.4 broactu,90.4 <br /> -- Giex-t*e. STATE v )1).- , q <br /> CONTRACTOR PHONE: 2. -3 cf. o so CONTRACTOR EMAIL(1/1,10.k)0, e., csyort2aftridot .coryi <br /> _ _.CONTRACTOR-LICBMSEA-REQUIRED ' CrIYOPEVeRETT-SUSINESS`tICENSEAREQUIREDI:1 0(rirCt g--- <br /> PRIMARY CONTACT: 0 OWNER [ 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 4.26 253 c:)5 -0 <br /> Tettb u2- <br /> CONTACT EMAIL:at403,0 a e C.Iin iteealriA5 CCD Ill ,4 <br /> ' •''' x- -- • --x-41U111..DING5F1ERMIT.AP.Pilla:T1014 - 4-,f ,")';--- - - - <br /> Existln. Use of aulldin.: <br /> Contract Price of Work:$ <br /> 4-opod Use of BultErai: Heat Source: as 0Electric 00t-ler <br /> 3iiiiiding Type OSFR-Deta.-...had EISFR-Attaz:bed ODuplex Cliviulti-Famify-0 of Units: OCommercial Dindustrial <br /> ape of prole:A: ONew CIAdclition EjL__ ,Remodal ORap . CIB <br /> alr OLTT n CISprinklCI <br /> er Demolifion OChan Use <br /> DESCRIPTION OF WORK: --------------------------- <br /> r <br /> te\SAO-4 u- netc--Q_,1 9ag viipftrl- io - cicnct°4- -f- <br /> 9-0,„S <br /> ASSOCIATED BUILDING PERMIT* -If a0D41,aklir,/' <br /> Typnce prw..t, _New ".„ .1i/tECHANICALPERMIT APPLICATION ,-;,K,UMBINGIPERIVIMAOPLICATION <br /> M #or ti of <br /> -PIX(Lff§r- --#1,,,ttirs e Fixtures <br /> allial NC-Air Harlan. Unita IIIIIIIIREEREININ MN Toilet MN Backflow Preventer inside Bid.) <br /> 11111.Forced Air Systems 11.111112=EMIN Bathtub 111111111=111111111.11111111111111 <br /> Mil Gas Piping IMIIIIIIEMEIIIIIII imi...._11111111Lavatory(Wash Basin Drinkin. Fountain <br /> IIIIIIIIIIIin eirigeratfr'n mom Shower am Floor Drain <br /> 111111111 Gas Fireplace mom Wood Stove MIN Kitchen Sink&bis °sal NM Grease Trap <br /> ............11111111111111ECUSEMMIIIIMMIL_____11.11.1 Ducting IIIIMI Dishwasher Mil Roof Drains <br /> iiiii Clothes Dryer Hookups nem Other; 111111111Clothes Washer IIIIIIIIIIIIIZCBL <br /> NM Rance Hood 11.11111111.1111111111.0 111111110MEMEMENIIMINIEN Other' <br /> 111.111.........m._13111111111111111111111111111111111 Ma.L..e......__lok Servloe/Baritvlo*/etc•)aanlla <br /> 1111111111111111111111111111111111111111 mime.....IIIIMIII6111111IIIIIIMMIMIMMlmmm..IMMMII <br /> SPRINKLERISUPPRESSION SYSTEM ' <br /> NM Chemical or Water OM No.of Heads IIIIMMIIIIIIIIIIIIIIIIIIIIMIIMIN <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 aulhcrizes approved work and no deviations therefrom Deviations must first beuth ri d In wrilln from the8 0 Zed p p <br /> Building Official before being authorized under any circumstance.I ern the owner,cr I am authorized by The owner cf this property to perform the the work kr which a plication I made, <br /> and I comply with the Slate Contractors Law 18.27 ROW and 296.2GOA WAC. <br /> City of Everett Official Use Only <br /> pEimc..) C <br /> Ow er/AuthorEzee.Age Signature \ Date <br /> , (Revised g/224016) <br />