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ire MINDING PERMIT APPLICATION <br /> OHM CIF E1r EN=WIi3N1nIRSERMADES <br /> EVERETT 5111MIMITITIAL 1dabi submittillI afteiciftlifttt stbarritttemu*rze it„tii,a►t rnurrlierraffaiwitesrreviiizatifbn-rreiziew <br /> AWASHffuraisTranow ttkerm damp off cumrpi:.:1(4()aggEllimedbrn alli tri itbriidio uurnorttsttID 31211DID car Stoat 2inutiIF{ImmrIfs Dap Ram. <br /> CONTACT INFORMATION:(P)425.257.88101(E)everetteps@everettwa.gov f(W)everettwa.gov/permits <br /> par Ow*Mass) PROJECT SUE 1AT10111 <br /> ROWE=SEE :: 47)/1 `l 3rd -ThUc FRMRCIEL <br /> Eveneibt- WoL gzo--- <br /> SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION tit applicable): <br /> 71811146411117151011111E35 f11191itt1E Off mmtl-rtr idkmdii110: <br /> ILEIGAL EI 1FI}IC lfturrrmwarar trurttam:att[vttPft tiliti viatan: llmttt> m:: Oittactharapiyalfltmapi ld#�st tmr)) <br /> CONTACT INFORMATION <br /> 0lmaa®M : ma c,` •► Y? rciuvi1 -e., <br /> OWNER PHONE(4 ) 343 5-6:5Z 'owNER EMAIL:YYl bo- 4I 3 c_orocas+ n-t4 <br /> coannagcnow COMPAINWMIME: ie I--C <br /> lIMA SMOTE 0 IROXCIRCEM OlfiWffiF Eatiffniffirllitl INE=111133ESESE tf,(REM MEM): <br /> CONTRACTOR ADDRESS: STREET <br /> r <br /> ua>Qr SMITE <br /> (DIMItfIIRAO(C1T VMAIL: <br /> W#IIOIOOACttr a7 ITA1 : 110XWAIIER2 CeItiiITA Ctrs ®Offi ER(tiPt„- fik) <br /> CONTACT NAME: CONTACT PHONE(4 ) ' " SD St <br /> Ma 9 ue 4 Ci -1�ft ai dmirclew :\\��.,���''ack__r+-1 4 3(kelyieri Yt_ <br /> VALUATION OF WORK:$ ©�000 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> pailiattmnilliirawml$tthe pErevaillirest iinnadietWallias affallittan.mattcrid*,airedEaviihnn®mn ti tbs.anattrylitte ales wltiffittearaftraiypazidi matt)) <br /> lEMISITIPSS ME OF EtIULLt : <br /> FIRIMPOSED tlttBE t : <br /> HEAT SOURCE: ®Gas Electric ®Other <br /> ®IIIEM klI1flfl :; e UTRavallranure E 0139X UMW ®Oltdtfi rrik—#tall uitm: ECkiniffealaisyStuitture <br /> 11151E IMF WIIRMIEWir(Om* DillavoLimittiurtfign EAtttlttuni �I it I�'(1 f..11. ElBtangxe off LU$w <br /> ThWt n tii ltsair EilPbrtalble IL111 f Ellattstimr,O ltt timm Dffarrrlt<(aibmie gpacuum0) Ell x aStbutztime <br /> DFence over 7ft NRh DRackStoirage ®Pool/Hot Tub ®Tank(above ground) 00Iher: _T <br /> EMESCRIPIIIIDMI <br /> OF : o-Q et4A-at�'jLr a ,�,Y� i A1dyt-�2_, <br /> t3,-v� - L Wit: �fl <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein Is true and correct Work done pursuant to this permit must comply with <br /> eavviemitballarall,sib,arrtdikcall/Famr.711hmetgortftmg®'fai{psvnittarsifywrtt,toiiffermp lurgriz'haradfrmIDelk:diadm8dm fllIDm.@tev6kfifioesmwettlfialtldteaullbimaimdliinwiittirgffom1ttim <br /> Mathicg aulthmitazetiuud§Tram}yaiiawnsti rroze.ltamrntffe(wo [aillarmautfrmii i/*Hive crawneroffltii&fifferipsWao greiffmm Oswalt((hurwiiiath.;,,,Ikattdmitsrrraak, <br /> anti il augnml4'urithr tfitr State tGaurtimko'liaaw 1133.2771RDMannti ;.21111AVXMC <br /> Clti; ffEwalt Offfeiall Wm OF* <br /> 30 oZ <br /> g2--t - 02- <br /> Owner/Auttroriz Signature Date (Revised 2#W2021) 1 <br /> VVV Ili <br />