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PERMIT APPLICATION
<br /> • BUILDING I MECHANICAL/PLUMBING I SIGN / SPRINKLER / DEMOLITION
<br /> #1111111P/411V/;:di CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET EVERETT.WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 /(E)everetteps@everettwagov/ www everettwa govibermits
<br /> , .
<br /> (Blue or Black Ink Only Please PROJECT BITE INFORMATION
<br /> PROJECT SITE ADDRESS: 1 Gl. ( 7 1-a, 7 11-1 IP:" I .'S C., PROPERTY TAX#:
<br /> LEGAL for i'ew construction Short Plat/subdivsion Lot No (attach oopy of long legal description)
<br /> ,AtilmmirAcT-1
<br /> OWNER NAME: 01 6-tr--?e,—v—, +44, ,..5 4..kil aerC) TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ct17 127 4- k 'te=.1 se.
<br /> :t•.E., E- v< #.. :,,,,,,,,,,,,,,,„ LA
<br /> *1400 if- 1,- I g 3 OWNER EMAIL: 4..4
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<br /> , ., • • , • . - .
<br /> COlittRACTOR.-,,i),t,r,.4 NWBATHWORKS, LLC
<br /> MftitikeloR ADDRESM, 18821144TH AVE NE
<br /> crry ARLINGTON STATE WA ziP 98223
<br /> 425-418-9545titii;i2Vi.:';;IEItIrii.,i''':i,ci ''i':', NWBATHVVORKS@GMAILLOrtit
<br /> iiiii:Be.l'i :: -4-..::,-:4Epoppo)k, NWBATBL855PA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57184
<br /> PRIMARY CONTACT: t?S OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: cifiS"-- 3 I8- Z 1 U
<br /> 11'7 0179 err i 4,4-c---- c..... pi,-e_f<L, CONTACT EMAIL:
<br /> Is,'IA
<br /> .......44,
<br /> BUILDING PERMIT APPLICATION
<br /> +.1.0.1
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<br /> xisting Use of Building, Contract Price of Work:$ $1100.00
<br /> Proposed Use of Building. Heat Source:" ';t:'-'. ...:; '0Lii:'.-;11,' 11'3.,; • ''.40:,.- '';:iitil',g‘
<br /> Bohclirig Typ4iit:, titffit-Ciiiitiog(00, lt 31g -lt.'-'ei.z. fig, .00.1.1Pittlq( 011ituittlitE, sal, illY-4,1*,> :::','''?'*;':'11:';'5:',:l'l':'.'t :!I:4:i.::'v,',',ij'.-,,- -,ell..i:;i•,,,',tn,f,,Z
<br /> T 4 of Project: :New DAddition 1:3Semonei EiKepair [DTI. Osign OSprinkter ODemolition 0Change of Use
<br /> DESCRIPTION OF WORK:
<br /> / /1 4,-4 . 5: c..s-- 11\e..,, 74-- 6,-,4-4..ck....r-- 71Z11 .1„t,/
<br /> ASSOCIATED BUILDING PERMIT#(if applicable).
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<br /> MECHANICAL PERMIT APPLICATIONOINCP
<br /> Type of Project: New Addn Alteration _Repair Type of Project: New Addn Alteration _Repair
<br /> of #of #of 1 Cal _____
<br /> List of Fixtures Fixtures Fixtures List of Fixtures List of Fixtures Fixtures PiList of xtufeif
<br /> Fixtures
<br /> 'NC-Air iiaridlirtg it* Heat Pump • Toilet Backflow Preventer tinsde Bldg)
<br /> F o i ceii A,r Systems Unit Heater Bathtub Urinal
<br /> 'a
<br /> Gas Piping
<br /> Boiler
<br /> Lavatory(Wash Basin)
<br /> Shower Drinking Fountain
<br /> Water Heater Refrigeration
<br /> Floor Drain
<br /> °-- Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookbbi Other- Clothes Washer Medical Gas
<br /> Range Hood 'AiNflitiif4eiiiif Other.
<br /> ,--
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.)- Other.
<br /> SPRINKLER i SUPPRIESERONIEVETENy
<br /> Chemical or Water I 1Nci of Heads
<br /> /- ''''''' '''"-"'"'''''''"'• ,' ''''Atili ;,'"' f',:/:.',., ::t;'" ':::`;;, :;-, ,
<br /> Aq .it:.;!:„." mEmr.i have my*AloS::1;:i",:::' ;Y ':: --i7' ;:.:':';'...,, ,,',', ,,:4;i4T,4,...:: ‘,*,,,,44*;:,': '',•.''',,', .'i.,**.r?,-;:,,,...,',,,,„,-,-;''..','-',':,:::;:r!li,,Yt417,,,•.
<br /> 4.--r, Thiflfi r,. ii,i,4i ,•;k-.,. TTC , 40,44*,,tiieli:f:;...,.,i,i,',..;4:,'''Jitgiti4Z/:.‘::-..:',',"..,,,:. : irii'''''PW7iitir,i..'
<br /> BrJfiding oirciat heroes?tevag aorhortred arf4rik,-,•A.,,,,;,„2„,,,,,:,,,,:;;:,:.,4k.,,,,,.,,, .-,,,,,.-,,,,,,,,!,.,.,.,,,,,,,, ,,,,,, ,,,.!,!,,, ,,,, .,..,..,., ,,....,, , .,..:,....,,„, „,„,,,, ,.,
<br /> sod i comply wdo tile State COM/WIWI ...t,tjt'rt.'''. ..,'K.'''...Z. (::.?'t'''-',!;','":,1,,
<br /> PERM(I% k.,% (..: Ic ...... (..) 9
<br /> Owner/Authorized,t.,e Signature Date (Revrsed 9/23/2016)
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