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PERMIT APPLICATION
<br /> /110111,2--A , __A BUILDING I MECHANICAL/ PLUMBING I SIGN / SPRINKLER / DEMOLITION
<br /> 4 CITY OF EVERETT PERMIT SERVICES
<br /> sod3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-2557-8857 I(E)eve .tep erettwa.gov I wrrw.everettwa.0ov>°permits
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<br /> I'Iti or k iti Only'' a } tJ :T ..; 11 A N .
<br /> PROJECT SITE ADDRESS: b (...) c d ,' d' (,7 ,( 'PROPERTY TAX#:
<br /> LEGAL for new construction Short Platisutxlivasion Lot No _ fattec1 copy of long Iegal description)
<br /> , , ,,•) �is8'li t$FQRM* N
<br /> OWNER NAME: k r e. Te)1/44-4.. TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 5 z...., y-
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<br /> OWNER PHONE' 4,77- 235- . . C !OWNER EMAIL: `.v-"-- `.....`.,
<br /> •CONT €3 E. NWBATHWORKS, LLC
<br /> _•;. T: 1882141,THAVENE
<br /> 0,,. ARLINGTON _ WA 98223
<br /> ,.. . t, . 425-418-9545 4', ir',;:;',,:'4,:",,,;":' N BATHWORK GMAIL,CO4
<br /> NWBATBL888PA
<br /> �� ';41p CITY OF EVERETT BUSINESS LICENSE a(REOUIRED): 57184
<br /> PRIMARY CONTACT_ 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> De-bi CONTACT EMAIL:
<br /> IVA
<br /> ,:.--:',,,,, ,c:',1';',,,,..,,. rim Contract Price of Work: $1100,00
<br /> Proposed Use of B ildxr€&g ' -. ,6 r a
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<br /> Y 1t ,€ rt ,1 t1 .;,.1„ v a ( E~tt a „ a, ^
<br /> Type Pr : ONew Addition DRemodel DRe aur 0T.1 SI r Cnrkler DDemoltion CC�arg�of Use
<br /> soDESCRIPTIC OF WORK:
<br /> ASSOCIATED BUILDING PERMIT a(ifappliccab7e: --i , - t;.✓ - .41 t
<br /> Type of Project: ,New Aden Alteration Repair
<br /> . ..
<br /> *of
<br /> Fixtures List of Fixtures Fixtures Lest of Fixtures /otu,T. List of Fixtures t€` List of Fbiettt S.
<br /> Fixtures Atc` Preventer d A€r Systems
<br /> »�Ai,
<br /> � I: Heat!?a rrp i -•• , reve r(inside BIO=)
<br /> tams Unit diaster Bathfub Urinal
<br /> G Boiler Lavatory(Wash Basin) 'Drinking Fountain
<br /> WA Retrlgeration Shower Floor Drain
<br /> G Wood Stove Kitchen Sink&Disposal. Grease Trap '
<br /> " Ducting ' Dishwasher Roof Drains
<br /> a,,,et , other: Clothes Washer 'Medical Gas
<br /> Range
<br /> floodi,
<br /> "' "Other,
<br /> Exhaust Fan Sink!Service/BariMopretc, Other=
<br /> IIIY�y. 1� `gip„..,>T ......
<br /> C �* .� I No.of Heads
<br /> L, € a+"3 r & fectt ffi r
<br /> am s sr rs a- :.
<br /> ^ rp ,i 3 r $i, _
<br /> PERMIT#
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