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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING
<br /> , /SIGN
<br /> /SPRINKLER 1 DEIVIDLITION
<br /> CITY R IRvIG
<br /> 220 CEDAR STREETVERET ,WA
<br /> 982Q1
<br /> (P)4254574410 1 FAX 42 ,4137411,357 I( }everettepe everetty ;gray 1 eAvw,tverettwaaovipertniis;
<br /> {Bite or Block Jolt Only Ple se) : `PROJEOT SITE INFO R MIATIO
<br /> PROJECT. ITE,ADDRESS 69,s , .....i ; TA. _ , ., , t1
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<br /> LEGAL for new construction: Short Piattsubdivwsion t� ot.No, •(atte h copy of Ion legal dfscnptton)
<br /> : ONTACT INFORMATION; `-
<br /> WNIt Til TAME: " .. , y r,; .o mere-lei):
<br /> OWNER MAILING ADDRESS: STREET f' /
<br /> rA, STATE 21e
<br /> OWNER PHONE; 4 . - 0 {tltAtfall~R,;EMAIL:
<br /> C€ t TRACT't F't NAME; Brennan Heetin
<br /> CONTRACTOR ADDRESS; smart' 4801 S 134th PI
<br /> coSeattleSTATS WaZit./ 9( 1.68.
<br /> CONTRACTOR PHONE: .2 -248-7'9.00 'CONTRACTOR EMAIL: aimi br+ nn nhe ti , qm
<br /> CONTRACTOR LICENSE tREouuR o): BRE N1 A ''1 R 9 n-s't� Ev TET f3U INESS Lttk til E#{RET ttlR tt> 0 82 0
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME, CONTACT PHONE:206-248= 80
<br /> Jaimie ti HowOWCOCONTACT EMAIL: ai `Ite W rennanhe tine }I`°
<br /> IV N IiN PERMIT`APPLIICAVION
<br /> 41
<br /> [ xistin Use;of Building: - Contract Price of Work: $ _ R:. .,,;
<br /> Proposed Use of Buitdi .: Heat Source: OGas l2 ctric °Other r m,
<br /> Building Type; eFR-Detached OSFR-Atlached UDupiex OMutti-Family-#f of U __ ©Cer tree ial 0industrial
<br /> Type oI Pro;est. ©Devi lAdditlon T Remodel °Repair CIT.I. ISign OSprinkter °De n °Change of Use
<br /> DESCRIPTION OF WORK: .�. ". `t t� .4,..c....„ x
<br /> L ‘� t
<br /> ASSOCIATED BUILT ZING PERMIT#(if applicable)
<br /> MECHANICAL.PE#t[l I T'A:( PUCA ONPLUMBIaPERMIT'AP 'L.ICil11"#TION
<br /> Type of Project: „_New Addn., Alteration _,Repair Type of Project: , ,Nee/ _ Acidn __Alterationy„_„Repair'
<br /> tt et #bf #•cif ' 4f,of
<br /> List,of Fixtures List of Fixtures List of fI*ture3 List.of Fixture
<br /> Fixtures Fixtures Fixtures Piktor°os
<br /> Ale, Air nIJlan :unit ieae: u p Toilet . .. _ ackfiew Prevent r Onside- 0g)
<br /> Fot ed Air System Unit Heater Betthtii� :Urinal,rinal
<br /> Gas Pipit* Boiler Lavat y(Wash., ste) Drnnkln Fountain
<br /> Water Heater Refriertitan Shower .. ,Floor Drain
<br /> Gas Fireplace Weed Stogy. Kitchen Sink,O. fliSpes Grease Trap
<br /> Gas Range Ducting h ishwastsa Roof Drain ;
<br /> Clothes Dryer Heckups Other ,..i, Clothes Washer Meis l Gs
<br /> Range Hood WaterHater "titer;
<br /> Exhaust FanSink( eryicet rtt topI t ,) ,Other:
<br /> SPRINKLER,1. PPRES IO i SYSTEM
<br /> JChemical or Water No:Of Heads
<br /> ACic C°WLE£GEMENT I have reviewed this oFFIltarrdn aiid cortfirrrs the lei tion contained herein-is true and ccrreef.Worts sne p.ur'subn tis ffh s passion must rpt with
<br /> current rederert,st=te,and local law The ranting of a perrmt ono autharixes app ved won*aril no d ata`ons therettere:peviestions must f et"be.euthotfed rn werog thg tram the;
<br /> Huttoieg Qifrc•kit=•am tieing authorizetf ender any cr cumst�e t am the owner ort am trutrtcrited y Tire c wICr Of thi i?rapertpr;to perforin 1h worst ftrr w rist appledd f rrrddedF
<br /> end i comptly wit. the,Stafe Contracts Lev,1E17 RW tt accA WAC, Cay of Everett 0#0011••40 t r3?y
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<br /> , pEln
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<br /> ,,, \.C;t()e. ---- 0-r(c)\ I
<br /> O.w ier': thorized Agent Signature D s (Revised 3/20t6)
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