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PERMIT APPLICATION
<br /> BUILDING / MECHANICAL/ PLUMBING I SIGN[SPRINKLER[ DEMOLITION
<br /> '01140'
<br /> talli:„7, CITY OF=VERETT PERMIT SERVICES.
<br /> 3200 CEDAR STREET,EVERETT.WA gS231
<br /> P)425-2.57--a31t) I FAX425-25T-335T I E,--)evaratteesa,evarattwa.gav l www.ever,ettwa gevipermits
<br /> 1(Blue ar*Black bile'Only Please) ' ' 'PROJECTSITE;INF,ORMAYIONner'lf ':,::":.
<br /> PROJECT SITE ADDRESS: C) A 01-1(i PROPERTY TAX ft:
<br /> LEGAL b-naw r:onst-uction, 3hd't?tat,;;J3d;v copy of long legal description)
<br /> CONTACT INFORMATION ' ' ' • ,
<br /> -----1
<br /> OWNER NAME: like..414 V,I3 P I ' TENANT NAME(if Commeralal),
<br /> „,—.....:
<br /> OWNER MAILING ADDRESS ,,,.-,.="' 105 416 0-11.1 SW 111 1
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<br /> 37A i•
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<br /> OWNER PHONE; # ip * 4 . 411° OWNER EMAiL:
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<br /> I ONTRACTOR NAME. lill , 'Pr— '-11,- Inc_
<br /> CONTRACTOR ADDRESS: SET 4. • 0 CUCiWO
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<br /> CONTRACTOR PHONE: 2.'b ct 0 SO !CONTRACTOR EMAtt.so Al 4 '`, I° AA !At 11 n.i >CO
<br /> --CONTIRAC-TQR-L-ICSEAREEIttiIIRE ): —INej liplizi ADP 4. — CITY-0?-EVEReTT stentesstreetts5 tO(REQUIREor—I Ofrict g
<br /> PRIMARY CONTACT: 0 OWNER iS(CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> CONTACT PHONE: 1+25 2.59r 055D
<br /> Doklio Liz,
<br /> CONTACT EMAIL:de cc)
<br /> ID
<br /> Exin Use of Buildin :
<br /> iCantract Price of Work:S ,....„-- .0
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<br /> Rraeasal Use af E3uildin' :
<br /> i-l'at Saurce: ;7!... 3 DElectri3 DOther
<br /> T ael 0.3-4R-Detaa.hei OSFR-Atta:nel a)tolas; Oklutti-Famil 4 ar Units:.. 0(33mmaccial DIrtti3F.rial
<br /> Ty.D..,3f P.:.),i,,..* 0N,bw DAdiitian ORemacial C1R3,3. OTT, Ds',1 D3orineer DDernalitial OCI.'har,, e af Use
<br /> DESC:EZIPTUON OF WORK:
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<br /> rl,ept,A., ej2—, (.., ,i5s 5 .\-- ,(_,Y--n
<br /> 4333C-lATE,D 3:,ift-DiN3 PERMIT f.4 C,f
<br /> MECHANICACPERIVIMAPPLiCATigN ' `:, ,': , ' ' ''''':l.,pLumeiNalkErtmitfAkplicArioN
<br /> Type of Project: _New Addn Alteration Repair Type of Project: New Addn Alteration Repair
<br /> IMM:=11
<br /> animmumam, Pump
<br /> allial NC—Air Handlin Units Fi7TrifLT —1-144° "4— .71:it9°1-i—T—omile—;-44" Fix444144----‘ Fixt#uarfes
<br /> Heat Backflow Preventer Inside Bid
<br /> MN arced Air Systems
<br /> Bathtub
<br /> Urinal
<br /> MN Gas Piping MIN Boiler
<br /> Lavatory(Wash Basin) Drinkins Fountain
<br /> w..........._...._.__1111.112MnrgaIIIIINBINIIIIEEZEMIII Shower
<br /> Floor Drain
<br /> menummusissammumm aim W c od Stove Kitchen Sink&DiS•OSal EIZECI:
<br /> Min Gas Ranee aminammusi Roof Drains
<br /> MOMNM Qathes 0 er Hookups •110111MEM Clothes Washer Medical Gas
<br /> Ran e Hood
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<br /> Other:
<br /> allall.......___ MININIMINNIMIMME I Sinktseniiiii !!:erdi,IIIMIIM%orAtc.)
<br /> 11.11111111111.1111101111111111111111111111111101111111111101
<br /> f 'SP#IINKLEFO.SUPPRESSION,SYSTEM
<br /> 111111MERMIMN Nc.of Heads
<br /> A CKNOWLECGEMENT:I have reviewed this eppiiceii,end ccnrer,ihe intemietii:n contained herein is true and correct Work done pursuant to this permit must comply with
<br /> current federal,state,and local law. The granting of a rarmi only aulhoriZes approved work and r,c deviations therefrom,Deviations trust first be authorized in writing frcm the
<br /> co,g CMG&before being authorized under any circumstance.1 an;the cwner,cr i am authorized by the owner Cf this pruerty ic perform the work for which applicalicr is made.
<br /> and I cmply with the State Contractors Law 18.:27 PC W and"Se.'"'CC4 WA C.
<br /> City ci Everett CfficialUse Cory
<br /> PERMITII
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<br /> OW+et/Autfierixed Age Signature
<br /> Dale
<br /> (Rawsou.;',/11/.7.-..1-1 41
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