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<br /> PERMIT APPLICATION
<br /> BUILDING / MECHANICAL I PLUMBING I SIGN(SPRINKLER 1 DEMOLITION
<br /> :` CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET EVERETT,WA 96201
<br /> (P)425-257-B310 t FAX 425-25T-835T I(E) lOt~tepseekrer4ttas t. goly I wawx.everettwa,govipermtts
<br /> iftlLB 4ediaC7C,IrF°7C34'e ?'PtFtia1!a ,>•'
<br /> PROJECT SITE ADDRESS:
<br /> ' 4+ .i�" PROPERTY TAX#:
<br /> tet.For new construction: Short s'13Jaub ivtsion
<br /> Lot No � (attach copy of long legal description)
<br /> OWNER-NAME �' . .
<br /> -,- ;• TENANT NAME tif Garntne#^Cte}):
<br /> OWNER MAILING ADDRESS: ;rRcE:r
<br /> W z PHONE: '' ' ' 01 t tr
<br /> (714 sr
<br /> OWNER EMAIL:
<br /> CONTRACTOR NAME, '''' :' .
<br /> CONTRACTOR ADDRESS;
<br /> aTgccT 1.
<br /> CONTRACTOR PHONE ''„,'Efia '��
<br /> CONTRACTOR EMAIL E
<br /> a
<br /> PRIMARY CONTACT: (]OWNER _
<br /> CONTRACTOR
<br /> b OTHER(Please Specify)
<br /> CONTACT NAME: t 1��C:rCl�H..�u2.- C�NTACr PRONE: '2Cj .,Z.� .. �
<br /> CONTACT EMAIL
<br /> � M I
<br /> E�14«,Use of But/din!!:, ' :. �.., , s ,,,...� . _
<br /> Contract Price of Work:$ : 0
<br /> ed Use.ofIrE...
<br /> €ta , T Heat Source ir.c s I s . Other
<br /> .... ,R- eta a e ©a
<br /> RAtta:had lliittpiex Mtil$1 arrtli. of nits ..
<br /> 'T p of,.P a act.; ONew DAJ it(an DRemode( LZCammerc(al Ct tdtl�tr (
<br /> ESCRIP'S`;ON ClF WORKi.a. Q it CIT 1. C.13,,x7 •rr ieA ODsn Demolition
<br /> A.'4OC14TE.BUILDING PERMIT# If r(pliaa'st "'"
<br /> rhe' 'Project: New ^ ei-114 ,t,.(:,';'-',',:4..".74 ti* s 1. PJa
<br /> Addn ,Alteration ft, M „ ,- Alt a1 i ' a
<br /> Reparr .�*. �w
<br /> M . „ #of Type of Protect: „New Addn Alteration of _-_.#of
<br /> Repatr
<br /> A1C Att { rid i ., ,tat(fia 3 ' `.�
<br /> r r Hest Puma FI____
<br /> ��ms stet � ,
<br /> Gas pi,,,'', knit Rhe-a .e: :. .l haf Pretrenter ,, d
<br /> 9atfitub '
<br /> Water Neater t "r Cfrt €
<br /> Reif 1. ratio Le tt{Wash a$1 }r} 1€t. otet ato
<br /> s bra. e .' Shower i r in
<br /> { ar # ate W.90 . tove Kitchen Sink& a 4 .
<br /> rHr tie1111=11 DUO wer
<br /> Ia e"41°4 Other: Ma ecf•i stile
<br /> INNS ,""Ia a r eater r' cg (Gas
<br /> h � t. Water H4 t+er" Other
<br /> s S!r#It.ar?ttTltx,+lee.; Other:
<br /> �F�>ttil i E ., 1' SSI
<br /> Chemical or Water
<br /> Nc cf Heads
<br /> ACkN0412EDGERfPNT,'1 have reviewe
<br /> current federal,slate,and local law Thad tss C eaPf „erft l y•pt a nfc tea cra t-�t itor t c dif l tru�•gdd r 4� a y re a tl 10 }s �Jt MOO C
<br /> EUilding dera.4 before being eulhcnzed lr r u 1 lit a l r I it tt iS w, r.er'I3tir,:iu(l ns, pb •
<br /> and 1 comply with the Slate Contractors flew iv' d.::a live Ned;, n,3 ref ,l f is'.4
<br /> • evly dorsa rr tlsl#rSt flet#tril crfzesll 1r- ' ."Ir rra;tNe
<br /> rd..2.1-04v d urdk' K',w,, .tt Saar 6.f•fltls moody to$tG .Ihxurtk fer'whf+Yls - „.
<br /> It as' ra
<br /> .. q 0 PER
<br /> city et Everett Official Use Orr/
<br /> t •
<br /> ,.04.arlA,:rtiV4 U. 8t _e$usr, ! ' • • 1 �g I
<br /> e .
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