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PERMIT APPLICATION
<br /> OIrr BUILDING / MECHANICAL I PLUMBING I SIGN I SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 99201
<br /> (P)425-257-3310 I FAX 425-257-3357 I(E)eva .ttaosp,3ver ettwa.pov I www.averettwa gov'permits
<br /> (Blue or'Black Ink Only P"ieasPROJECT,SITE VINFORMA` ION. W
<br /> PROJECT SITE ADDRESS: -----
<br /> 4 Y'Q( c _`'[-- Aim "" PROPEE
<br /> LEGAL' ':naw car•Y u- ol. 5',0 a* . ,. t T R l• RTY TAX f#.
<br /> Ua t aEan
<br /> -- -----____.._.._�.._......i-ot No.� (attach eo?y of long legal description)
<br /> OWNER NAME: OS j �� �"'i
<br /> CONTACT INFORMATION .
<br /> TENANT NAME(If Commercial,): _� .
<br /> OWNER MAILING ADDRESS: ---.,7,7..*
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<br /> 0 tit
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<br /> :OWNER PHONE: Q" it ♦ 1 r� .Ta,-_ Lori.
<br /> s OWNER EMAIL:
<br /> CONTRACTOR NAME: fV)
<br /> CONTRACTOR ADDRESS: t -i act_ ,,g
<br /> cm( Jur ",Ir%-
<br /> CONTRACTOR PHONE: O STATE LIP # : 2. 1
<br /> 0 CONTRACTOR
<br /> EMAIL.*�. 4 ',r -1A
<br /> AA .0 a 111 no .coal
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<br /> —Ai i"ps , ' , ,tt•
<br /> .. csrYCIP-EVERETT'1trttrl~sstica:wseeecsur>zEo ' fs
<br /> PRIMARY CONTACT: 0 OWNER R
<br /> CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> T1,,,,�c CONTACT PHONE: 4.25 2C3 05
<br /> �J `J CONTACT EMAIL: . 1
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<br /> -a4BuILDING'PERMtrVAPOItAtitit1' <� Y
<br /> Euiatin Uso of Buildinr:
<br /> Contract Prfce of Work:$ Q
<br /> TMoposed Use of Buildfn :
<br /> uifdin T Heat Sour :
<br /> "� !...003:;tri::: ❑Other
<br /> FA aha'i ❑DliDiaY ❑�Viulti-Fami( -, of Units: ��
<br /> Tyne of P ai t- CI NOW- ❑AddiFio�7 oa...rn ❑Cammerciat ❑Indu,tria( j
<br /> DESCRIPTION DF ❑ . to el � 'e7si, OT 1. ❑3i.n �oarink,h: ❑ _
<br /> WORK:
<br /> Dsmo(itian ❑Chan_of Uss
<br /> ck-keSS 4)La-ryy
<br /> ASSOCIATED BUILDING PERMIT f€{.f.dp7 f,.:aa,,y),
<br /> MECIt0.IrIIC{tL:pERP1iIT.AP.PLiCATi47W ` .: -,'
<br /> Type of Project: New Add5 PLUM
<br /> n
<br /> Alteration BII�Ct•'�PERIVI!`I`�rA�'i�t�TCATIt��i
<br /> #of ,Repair
<br /> rX ur ; .._._ 1'5"11,FlxWres____.--- #of
<br /> �A/C—Air Handling Units Frxfures !!lsff oFixtirrss—
<br /> ,A/C— Air S" eget Pump Fixtures
<br /> 1111.1111 —
<br /> Inn
<br /> Toilet
<br /> Backflow Proven ter
<br /> Gas Piping Bathtub
<br /> (Inside Bldg)
<br /> Boiler MN Lavatory(Wash Basin Urinal
<br /> `" ° Shower Floor
<br /> Fountain
<br /> Gas t�anae bVood Stove momKitchen Sink&Dis6caal Greaseoon Tr
<br /> iiiiiiii_Gas
<br /> t7 _ Dishwasher Tragi
<br /> er Hocku,sinung Other. Roof Drains
<br /> Ran °dd Clothes Washer
<br /> Medical Gas
<br /> allimbanniminamillinallimmum ,...111111111111
<br /> MN Water Heater
<br /> Other:
<br /> nllgillk..__IEBIMMEallMMRIIIMIIII.hllIl MN Sink(SnricelBarlMcpletc,) Other:
<br /> SPRINKLER;I-SUPPRESSION SYSTEM . ,' ';
<br /> MN
<br /> MI Chemical or Water MUM
<br /> A 1CttGwtEa�GEla Nc.cf Heads Mill
<br /> ENT:I have reviewed fdr%ar/Itreticc And cehriesa are leferrheecn ecrtatred herein is tree and cared,"Arrrtr
<br /> current federal, Wale,errd kcal Few. The eras tit g rd a f;grt,,;'nl,atritcrizatl enrrrtied w•crk and tar..ceutattcas fherefr
<br /> Stalldrrp C1t,`sial before L'elng aUti,crrzerl unC%r of tf`ce`Tt+rinart Cc this arrrtY must cc
<br /> arch Cg CI:
<br /> r ial b the State out h etas tour 7 a f circtrr;,,f:3r:tn 1 r,,,the c:'1rer,cr I ea;aatff;crazed ty th X cwrer cf this property ter rfrrar.the wed,ler which willing
<br /> Vie✓writ.
<br /> tZCWaa.d 66.2CGA WAC. frGrzart;-
<br /> Xf-ftCTal�F7 i5 FP:�A FaI.
<br /> City c1 Everett Cificiat Use Ci
<br /> .,� .. ''
<br /> P T
<br /> Ow,or/Authorized A e_ ♦ 1 �� c)�
<br /> 9 Signature
<br /> (^ y baa
<br /> 1 (Revised 9/2312C16)
<br />
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