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PERmyr APPLICATION <br /> i BUILDING I MECHANICAL I PLUMBING I.SIGN I SPRINKLER I DEMOLITION <br /> ClfY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98291 <br /> "+ <br /> (P)426-267-8810 I FAX426-257-8867 I(E)evorettaps@t3verettwa,govlwwweveret(wq.gov/permlis <br /> ffPROJECTSITNADDRESS: <br /> PROPERTY TAXA:construollon: Short Plal/subdlvlslon_ Lot No. (attach copy of tong legal description) <br /> OWNER NAME: p Vin TI~NANT NAND t(If commerclal): o N$1 <br /> OWNER MAILING ADDRESS: STRER P'��{3o)e <br /> crrr ICU vwOtT STAW L0 A zrn <br /> OWNERPHCNE: 20(O" 1OWNER.EMAIL: p.5er~ar� - tt � . "4. <br /> cON't'RACTORNAMF: Cv �� A-} <br /> coNTRAGTORADDRESS: STREEr <br /> STATE W zrp �ZD <br /> CONTRACTOR PHONE: �Z�-2;�P�1! CONTRACTOREIvfAEl.: /v��aww jgM" .�-�-- <br /> CONTRACTOR LICENSE#(REQUIRED) go-, ®2 D CITY OFr 1~VERETT BUSINESS I.ICENSE#f(REQUIRED): O g <br /> PRIMARY cONTACT: El OWNER VkcONTRACTOR CI OTHER(Please Specify) !j <br /> CONTACT NAME: CONTACT PHONE: 14 2 5'_WPI <br /> I <br /> lam/ CONTACT EMAIL: Pak i'ls `•- <br /> " " �r�tirIti�PtlllrT 'i'rf)i <br /> Existing Use of Building: ?`I <br /> p e d Contract Price of Work: ?D <br /> Proposed Use of Bulldlnff: 9V 4 Heat Source: L7Gas C(Eleetria CEOther <br /> Bullding Type: CISFR4Wached ElSFR�Attached CIAu lex 1JMulll-F8ml1y7i80f Units: Wcommerclal dlnduslrlal <br /> Ty e of Pro ect: CINew IlAddltton ElRemodel WEePaIr [IT.).,�ClSlgn CIS rinkl!lertt..--CEDemolltion 00hange of Ilse <br /> DESCRIPTION opwoRK; .4 wTu <br /> t rj 6 zx wv A d &W(QnLzv4 tAP-5tj_4_ <br /> ASSOCIATED BUILDING PERMIT 1A(if a licable: <br /> • ;tV1'����tE1K�,ftI�,1�>�t�t�il9'ls',fAlt�P'1Lr��Tr®t1'f PI<,>�ilVl�rf<�t®�)dt�IVtk`��IPP�,�C.�`�rD�9 . <br /> Type of Project: —,Now— Addn _Xforatlon Y—Ropah• •type of Project: New ._,Addn __1lteratlon ,__Repair <br /> #oflistofFixtures #of listoPF/xfures of List ofFlrtures #of list Of Ixtur" <br /> Fixtures F/xtures F/xfures Flxfures <br /> AIG—Air Handling Units Heat Pum Toilet BackflovlPrsventer InsldsBidg) <br /> Rowed Alr Systems Unlf Heater 113athlub Gas Pl fn Boller I Lavatory(Wash Basin DrInking Fountaln <br /> Water Heater Refrigeration fShower IFloor Drain <br /> Gas F1re face Wood Stave jKlIchan Sink&Disposal lGrease Trap <br /> Gas Range Ducting DishwasherRoof J)ralns <br /> Clothes D er Haoku a Other: Clothes Washer Medical Gas <br /> Ran a flood Water Heater other: <br /> Exhaust Fan S1nk Service/Bar/Mo /eto. Orhor: <br /> Number of Heads <br /> ACIfNoWlEDQ1;MEN7 !haus rovieraed lhls appllcallon and conf/m�tits information contelnad herein is true and correot.Work done pursuant to this permitmust comply►viii) <br /> current federal,state,and locallnw.The grenilrtp ofa permit onlysuthorires approvod work amino dWatlons therefrom.DoWtona must prat be authortzed In wrRing from the <br /> auJ/ding official bsforo being euihorfied undorany a/rcumsiance/am the owner,or <br /> lam authorized byiho owner of this properly to perform tie tivork for vvhlch appHcailan is maifs, <br /> and/comply Wlth the State Conlraclors Lew 9e.?.7 RCW and 29s.2a0A WAC. City of Evereft optlai Use Only <br /> . !vkd <br /> Dato {Re0/201) <br />