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iPERMIT APPLICATION
<br /> BUILDING / MECHANICAL 1 PLUMBING ! SIGN [S P R I N K L E R I DEMOLITION
<br /> CrTY OF RETT PERMIT SERVICES
<br /> POO CEDAR STREEEV
<br /> T. ERETT,WA 93231
<br /> CP)125-25T-3313 1 FAX 425-257-3357 I 2,)avaratte...psp,,wara'.twa.gaw I www.avatattwa vipoe'ml,s
<br /> .._....
<br /> (3 iue or,Black inf. ."--"' 71:7F—tc73-1CTIs I TS 4 NFdit miktiowfw:‘..;,f.- '''T.:'-',.:
<br /> ECIS
<br /> ........ .01.....mnxeees...1
<br /> °I......... ..LE_1222172.....,.... 1 4."17 1.,...- 'PROPERTY TAX if: —
<br /> LEG _
<br /> AL f..I^-,i,";:-",Dr13.aft.`.‘fail: l',!ati3ub.:Iivis oi
<br /> ..................______ ,......_.:..... ...,
<br /> Lot No. __ ',attach copy of bilg legal cte:nnption)
<br /> CONTACT INFORMATION
<br /> _
<br /> OWNER NAME' €, * * ......r a ill TENANT NAME(if Commenial):
<br /> OWNER MAILING'ADDRESS, S''' - 109 pi_ svv
<br /> 37,5.7, A
<br /> OWNER.PHONE: ap -3"D,a . 41"14 OWW*R EMAIL:
<br /> — Ail
<br /> CONTRACTOR NAME. l'I. 'n. ' rv- In c
<br /> CONTRACTOR ADDRESS: sTR:F.r 14- • Oa-6LO ill
<br /> a,,,tt
<br /> STATE A A-- z,. * : 2. 1
<br /> CONTRACTOR PHONE: 2 Cl. 0 SC) CONTRACTOR EMAIL...0 A if %.1 1° A A ..P.11.1. II n.I •corn
<br /> - 4--CM-T-RACTOR-LIC;€4SeAREEMIRED):- jia igi *Elia;IP- re--Oit eVERLITr-stISTNESS-LICENSEIttREOCIIRECtr
<br /> NZIMARY CONTACT: 0 OWNER EYOONTRACTOR ID OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> CONTACT PHONE: 4.2.6 2-5'? o55-0
<br /> 1)eAlto(-0-
<br /> CONTACT EMAIL: • a 4 a - • item 0 .co
<br /> - ' ' - —,,,lUatilt.DINGt'REKIVirriArlfetatio ' rrjiX04P"':''
<br /> Existim, Use of a,Jitcrin : dr lairzniminimmimmim
<br /> ac7ntriat Price of Work:$ st.,. —ee...-;awdeemeemee
<br /> . i.00losai Usa of 3tiildin-;
<br /> Haat Si- Z:43 DEleatria. DOI:her
<br /> BuiIiil T D ... DSER.-Datac,ttei 03FR.-A!!3:hai 0DiJoieK. 0Mtil,1-7-7aalily4 o,Units. 0Commarcial 011Jus,:tiai
<br /> Iyae:of PT30:,•-!: ONaw 0Atiit: ri 0Ramadal 0Rapa',- 0-I, 03,11 03arirtitiPr 0Demailtion 02.11ar71,DI U-5e
<br /> _ _ ,........_
<br /> DE.3.:,,,RIPTJDN OF WORK:
<br /> (Wit-CACL 6-
<br /> 4.3 :IATED ilLOING RERNIrr o uf 33,:;;;3,),,),
<br /> MECHANICAL PERMIT ', ;:: p1,11MBINWOJERMMA#P,LICATION
<br /> Type of Project: New Addn Alteration Repair Type of Project: _New _Addn Alteration Repair
<br /> #of #ltrii of
<br /> 4'of
<br /> Li st of..3;i -.iures--. ListLafFixturec ----tistof-Fixtures-,-- —
<br /> 'F ?Fs—
<br /> t-xtUres
<br /> Fixtures
<br /> aliMIN AJC-Air Handlin Units allimema 111111 Toilet
<br /> eackflow Preventer(Ins!de Bldg}
<br /> 111111111_ _Ir................____Forced Ar Systems 1 u r11111111111113 ...m-leater—
<br /> Bathtub Urinal
<br /> 1ZEU=
<br /> 111111111....___a5 -IriUnilialanellellailliall 661er !Lavaory(Wash Basin) Drinking Fountain
<br /> ......._111111111111111.1.1.11 Refrigeration MIME Shower
<br /> Floor Drain
<br /> mum Gas Fireplace Min Wood StoveMIN Kitchen Sink&Oisfosai Grease Trap
<br /> 1111111111gannallaimillinCuctin
<br /> 1111111 Dishwasher
<br /> Roof Drains
<br /> MIN Clothes Dryer Hookups 11111111 ME Clothes Washer Medical Gas
<br /> MilliRan,e Hood
<br /> 1....._11.1.1111111111111 . an.Water Heater Other.
<br /> 01111111........1._IMMIUMINIMMININIMIIIIIIIIIIIIMEMIE allall Sink(SerVice/Bar/Mcp/etc.) Other:
<br /> 1.111/611111.1111011.1111.111111 111.1.11.111111111111111 al......_...1111111.
<br /> -'SPill NKLEFUIS UPPREn......_Ss ION:SYSTEM --'".': MI
<br /> 1.111111.1111MEIMINIeads 111111 '
<br /> ACKNOWLECGEMENT:I have reviewed this egg/ice/xi:shd hfirthe Inkrmeticn ccriaired herein is true and correct.Werk done pursuant tc this permit must ccrnply with
<br /> scut:rent tederat,atate,enc/focal law.The granting cf a permit only authcrizes acgrcved wcrk and rc devieilcns therefrcm.Cevielicns must first be authcrized in writing from the
<br /> 11111111111.11111111111111111111111111111111111111.
<br /> Lidding Cfflael befcre tem9 authorized under any circumsterce.I air the cwrer,Cr I em euthcrized ty the owner cf if7fs property tc perfam the wcrk ic,which aggiicalicr is rrade.
<br /> ard/ecrng/y with the Slate Centractcrs Law 10.27 FCW and 2S .200A WA C.
<br /> City cf Everett Cfriciel Use C,t1
<br /> FE MIT 4c-1 1 ,....,yr-Li
<br /> —410 Lk .Alt..%.... _ 1 \ • a t(?)
<br /> Ow,er/Auttacrized A94 Signature
<br /> te
<br /> (R$5weed 5/21/2c 16)
<br /> r" Da
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