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04:77- PERMIT APPLICATION
<br /> BUILDING / MECHANICAL! PLUMBING 1 SIGN I SPRINKLER!DEMOLITION
<br /> cry OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT.WA 93231
<br /> CP)1-2,5-23T-3311 I FAX 425-25T-335T 1 i'-..*)everetteaseverattwa.gov I www.everettwa goviper-mit3
<br /> (Blue or'Black Ink'Only Please) '• 'PROJECTSITEANFORMATION':'W :.:'-'0.z,` ",•1;..:.'.• . ___
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<br /> PROJECT SITE ADDRESS: '(..) ri, yli CI , . "E.,_ PROPERTY TAX ff r‘.. 4. '
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<br /> LEGAL C3r naw3Onstitic'ion,: )'iort Plasul)divIglon-- _ at?Ir.:h copy of long legal descrIption;
<br /> MCONTACT INFORMATION ' '' 'MITMIIMMINIP/Ir , V1 C TENANT NAME.(If Commercial):
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<br /> OWNER MAILING ADDRESS' sr,,,-_,:r.1 ' ?•"4-1 2-41C1 (-)11# c-- ---
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<br /> OWNER PHONE: 1 S- - 1...)-5— 1 Le V2.-- OWNER EMAIL; in .6
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<br /> CONTRACTOR NAME, Y) ‘,..1.ea,1n In C.
<br /> CONTRACTOR ADDRESS: sr4;-- ' 114. , Ort-Ctu.)-
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<br /> CONTRACTOR PHONE: 2.1:5 CI 0 SO CONTRACTOR EMAIL.o..,41.4 '1/41 7 AA ! di II rt a •Con-i
<br /> :CONTRACTOR-L4(.;E' 14,SE4fREatitiR3i: -.06 eSA- -.*-=• — ITYIDP-Eyelurrst/SMESS-LICENSE-4t(REQUIRECrIt--
<br /> PRIMARY CONTACT: 0 OWNER VCONTRV3TOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> CONTACT PHONE: *2.5 2...5• 055D
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<br /> Debb L.2.
<br /> CONTACT EMAIL: *.44. a a • ilea, . •co.
<br /> .-,uguiLDING4.1EittotiApc4141-10.14te-fv1/4PWOITA"'"--.".'-`-i'7---:
<br /> :-..-x-istln Usa of Bt..sildin,: Contradt PrIca of Work:
<br /> =,-,04 U33 Of Bultdins: Haat r-=: 033.3 IP a:::t.;tt: Ebther
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<br /> C. . i FR-Data:thai 03FDo14.K D\ :=-Farnity-4 Dr Unit3: OCJramarr:ral DInJu-stria[
<br /> 0 NeW .rir Alli',;4430 OR3M /3 - DT.i 03' I; 03arinki7 CiDamafftbri Ochlrt 3.af U3a _I
<br /> 3:77..-3C..-:RIPTION OF iiT,RK:
<br /> ci./I- r IA 1,r) 1 ,,,,, 5 1 i i itii „.4„,,,1
<br /> A3-3D:',:iAT.ir:a 3.XLDtKi3 PERMIT#Cf a 30 )[,3):
<br /> MECHANICALf,P-RIWIT APPLICATION : ' ' ' -- '.A.' PLUMBINWOtRMIttOPLICATION
<br /> Typo of Project: _New IP'
<br /> Adan Alteration Repair
<br /> stasuaka Fang... __Ltst,ca.F.xturas- Frtc-w.T#°F Li (F.Ixttinag—
<br /> Ma 4°f
<br /> Fixtures
<br /> allill A/C-Air Handing Units 1111111111 1111111 Toilet
<br /> Backflow Preventer(inside aid,)
<br /> Forced Air S sterns 1111111110ZUMMIN ....._______1111111BathlUb Urinal
<br /> aiMIIIIIIIIIMI E3cM$r WM Lavatory(Wash Basin Drinking Fountain
<br /> allillumwmaummuminiliRefri.eration Shower
<br /> Floor Drain
<br /> Gas Fireplace
<br /> Min Wood Stove MN Kitchen Sink&Dis osal Grease Trap
<br /> anienzammarni min Ducting
<br /> _MIMI Dishwasher
<br /> Roof Drains
<br /> an Clothes Dryer Hookups 11111111111110ther: Clothes Washer Medical Gas
<br /> Mil Ran e Hood
<br /> aIMIMIMIIIIIIIIIIII MN Water Heater Other:
<br /> immik________emmarzaimmuminimmins. min Sink(ServiceiBar/Mcp/etc. Other:
<br /> aIMIMMIIIIIIIIMII imme......111111111
<br /> SPRINKLER I-SUPPRESSION SYSTEM - ''',.:: IIIIIII
<br /> _ MMMNc.Cf Heads IIIIMIIIIIIIIIIMMMIM.m .
<br /> A Cl(AtDINLEDGEMENT:I have reviewed this applicer)cc and confirm rhe Information ccriaired herein Is true and correct.Wcrk done pursuant fc this permit must comply with
<br /> cusrent federal,state,and local law. The granting cf a permit cnly authorizes approved wcrit and nc deviaficns therefrom Deviations Must first Le-authorized In writing from the
<br /> a uilding Cfficial before Laing authorized under any circumf.tiarce.1 an,the owner,Cr!am authorized ty the owner of In:property to rerfcrm 11-,e work for whinn applicalinr is made,
<br /> and 1 con:pry with the,State Contractors Law I a.:27 F.C.v..•and 2S6-106A WAG.
<br /> City cf Everett Cfficiel Use C171'y
<br /> PER t**".'.." .".""""";".. .".."..""'""'"""L"f""......".." 1
<br /> 2 , • 1
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<br /> Ow,er/Authorized Age• algnature
<br /> Cele
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<br /> Ritsel ry/23i2C16)
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