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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION
<br /> #1111111g-""41
<br /> Irmaa
<br /> / CiTY OF=VPRETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT WA 34231
<br /> (P)425-25T-3313 I FAX 425-25T-3357 I E)everetteostleveraltwa,gov I vvww averattwa g) pmts
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<br /> (Blue or'Siack Ink Only Pleas0 . '-' -PROJECT 4ITEIINFORIVIATIOW-W,:;-f'zi '-': ' I
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<br /> PROJECT SITE ADDRESS; (, 1,c.
<br /> PROPEFay TAX/4:
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<br /> I EGAL i-i:n,e„-,,,,c.on.I.-Lictio,1- Sho t P a'isubii..e., ,n_, t,,oi l‘lo (aitacn copy of hog legal ciptioo) 1
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<br /> CONTACT INFORMATION ' - ' -
<br /> OWNER NAME: A /1 (D
<br /> NT NAME:If Commercial)
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<br /> IN" ",„ mai z::E.NA
<br /> OWNER MAILING ADDRESS sr,r-i I- Ci't' Vci SA S E
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<br /> _A.)A- ,,, C3 --2 (49
<br /> DWNER PHONE: k; -* 1 ,.-') 1DWNER EMAIL: jA C
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<br /> CONTRACTOR NAME, )/r) WatiTy ,irl c
<br /> ;CINTRACTOR ADDRESS: OC,L,CL,L)
<br /> c:1-Y .4e.)/r
<br /> STATE \JO fi-, 1.:P gig
<br /> CONTRACTOR PHONE: I.,-,' 2F-3 q o o CONTRACTOR EMAIL.t ,.. 4 '`, II ,jili _0 tg, lits .con,
<br /> _ .. CONTRACTOR-L-4;;E4SE-fAtar-OUIREDt: ---CA-44EEPt- ki--Cx15Ri4.-------arY-0?-EVERETT IStISIIIZSTLICENSE-1(REQUIREDriefrrCt-g— -
<br /> PRIMARY CONTACT: 0 OWNER kw"CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> CONTACT PHONE: t4'2.6 2_53 0550
<br /> 'Debi°u2,
<br /> CONTACT EMAIL:de,4130 a cuyt,ttecx,,+t .con/L._
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<br /> -..,isu1LDING.,!PERMIT'API*ICATIOMILM'''',11,4MtVv.° . -7
<br /> 7iciatin Use of 3Adin :
<br /> WIBEIrradlin
<br /> Contract Price of Work:$ miusimen
<br /> ›Toposel Use of 3triloin,:
<br /> H-at Sour-rs.: DG 33 .'t deztri:::: 00ther ____ _
<br /> Suiliin T'oe: : :-.R-Detaz.fiel OSFR-Atta:i'w.i 0D • 0,V10aiy-i*DC U'ltt.3- 00ornmeri 0Incfus'FIaf
<br /> Tyoa of P ',lew DAldit:oo 0 RernoJal ORaol' OT i Os, il D3Proklar ODarnolition OChart o of 113o.
<br /> DESCRIPTION OP WORK:
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<br /> A333aiekTED Briti_DiNci PERMIT# 'I`.a Doilaile)-
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<br /> MECHANICAL,PtkritIT APPLICATION `-,-': ; ' ' '- POMIBINd'PERNIIVAPPLICATION
<br /> type of Project; New Addn 1.. Alteration Repair Type of Project: _New Addn Alteration Repair
<br /> #of
<br /> #.ixfures
<br /> A/C—Air Handlin* Unit5 si........__1111111111MMEMm II..i.m.mstmer......_MIIIIIIIEEaIIIIII.memsEuagrer 0 n sl de Blds,1
<br /> F°1-Ced Air Systems .....____MOMMII ieligglaill. giiMMNINIMMh6.'qqllMIIIIIIIIIIMIMBBBIPPP4AIIIIIINIIIIIM
<br /> Gas Piping
<br /> MIME
<br /> 11.1111111111 Boiler JLaVIO (Wash Ba " OH ' g Fountain
<br /> _11111MMEMMEIIIIIIIIIIII __IMINIERefrigeraticn Shower
<br /> oar Drain
<br /> MEI Gas Fireplace 1110.1.11Wood Stove Kitchen Sink&Dis.osaf 71rdNEMnzmmmmiw
<br /> NIIIINIZEMEMMENNIMangumm Dishwasher Roof Drains
<br /> MN.Clothes 0 er Hookups 111111111110ther 11.11111E_ eime=11,1141111111111111.MLIedioaf Gas
<br /> alaill Ran e Hood 1.1111111.111111111.11.11111 WaallenaillCMMallpr 0711111111111111.111111111111111111.
<br /> IIMIIIIam...._.__MEEININMINMIimmmmnm...._IlMIMMMNIMINIIIIMII INMIMIEMEZr,,AZWSEMNNIMIEaMaho".II.M.M.M.II.
<br /> 11111111111.......... ii: 1.1111111Pr-4111111111111.11.111111111111111111111L
<br /> ' 'SPRINKLER TSUPPRESSION SYSTEM
<br /> 1111111011=0:101 No.of Heads
<br /> A CARC INLECGEMPIT,i have reviewed/his spoisstics e,r,d,;c4tim,iiwon:earn ccriiairieri terse;is true ord ccrtocr.Work Oct:e Fursuvrt ic Ii.s gem/muss rcfroy vim;
<br /> "rrer't r"tal,4'ala,e/'d icc8/law The ia$ a a PWrTat CI*awl:oft:a:I,sp.p(CE eo Azrk and gc deviaticm.lierefrcm,Ceviettons mist ast te Asuit:crfretd in wilting trcrt;01,,
<br /> Eui1dig9 Calaf tekrd ii emo autt:craEri under ary oiroorrotatIce I at^.ihi3 mvse.r cr I arr aulticrized ty tre cveler ri itis prcresty to gorkm the;,,,ort,kr wheir:Arrtkaitcr s
<br /> zinc,/cry will:the rStafv Ctrarzocrz Law le.Z7 PC Is,era/2tE 2CCit i+VA C
<br /> City 0 Everei Cificial Use Ca:t?
<br /> FERMI
<br /> -24 0 / 1 IA
<br /> Ow,eriAulhorIzed Age Signature
<br /> CPle
<br /> 1,58d 5/23/2 16)
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