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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER 1 DEMOLITION <br /> elp <br /> CITY OF EVERETT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 't"425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwagoy w eeerettz g°v/permits <br /> (Blue of taOkehiliCatrti Blas sti _ 1 <br /> PROJECT SITE ADDRESS: <br /> G' PROPERTY TAX#: <br /> LEGAL for new construction: Short Ptatietibdtvisioti <br /> Lot No.* (attach copy of long legal description) <br /> OWNER NAME j t _ �, ",` e <br /> OWNER MAILING ADDRESS: STREETAi <br /> u <br /> ,. l <br /> � • a (If Comma tcj�e <br /> TENANT NAME <br /> 2.t c <br /> QQ m ' <br /> CITY_. •'.�� , <br /> / STATE LA..)ti- <br /> zp gg2c <br /> OWNER PHONE. zs D! 45 0OWNER EMAIL:,. <br /> CONTRACTOR NAME: ,; 40 <br /> A ; Ott <br /> CONTRACTOR ADDRESS: STREET it+ <br /> CITY mi. d. <br /> CONTRACTOR PHONE:' STA z� ad <br /> q 0 ONTRACTOR EMAIL.4., 4 4 '. <br /> =.A.,4"std " d + s F'SVERLITratt -- <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> "D . CONTACT PHONE 25 .5 2 . <br /> CONTACT EMAIL 6,,, ,a 7 Te <br /> lt ferillall <br /> exist' i Use ofBPI. 2; <br /> Contract Price of Work:$ <br /> Prot.Sed Use of Btttfdi <br /> Heat Source: as ❑Electric ❑Other <br /> Euild= T °e -� FR�etechetfi ❑SFR-Attached QD .lex ❑Multi Famil 4 o Units;❑Addition <br /> I •e ojst�o 0 e <br /> ' ow ❑Remodel ❑�, i]Commereia! ❑Industrial <br /> °a of TIOlf:f3# WORK:. air ❑T,I. QSt°n OS.rin'' tje' ❑Demolition ❑Chante of__Use <br /> RePIfte s as `r ICXCeL. <br /> ASSOCIATED BUILDING PERMIT# if a•'°►!cable _ ` <br /> [t :AP rt' Lit I L.: N y ,S ':,:".14. S St .. X!Rdal hi ■f ` - V_ <br /> `Tyxe.of Project __New Addn AlterationAe air <br /> #. f ; p Type of Project: New _Addn `Atteratton _Repair <br /> A/C r��t s tai�:� > Ifures' Fjxfu es s�tst gt��"wtrturesr --n <br /> Heatr ,FToilet orced Air S tams r �ttft€s�u,i'ra rttet+Oneida,/31 )` <br /> ►nd Heater Bathtub <br /> Gel Ppl � BoNer Urinal;. <br /> Water Heater Laval qtr Basin <br /> Rte'-at rtton Floorti Fountain <br /> Gas . 5t°tn+er Floor Thain <br /> . . Wsod Move _ <br /> Gee Ra Kitchen Sink&Disposal Gee Trap" <br /> t.`. 4, Dishvsh <br /> Clothes 0 er Hookups ' ,, Ott et RoofDrains s R M <br /> � ' vtf�a$W�s �r tf�etfiiI Gas <br /> Water Heater <br /> Exhaust Fan � Other. <br /> • &nk 5ervlce/$ar/Moptatt� Other - <br /> ` xlltINKKJsUUPPRESSIO W , <br /> Chemical or Water <br /> No.of Heads <br /> °ACKNOWLEDGEMENT•1 have reviewed this application end confirm the Information contained herein Is true and correct.Work donepursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18,27 RCW and 296.200A WAG. <br /> City of Everett Official Use Orey <br /> PERMIT <br /> Ow eriAuthorlketi.Ay 'Signature410. <br /> Q_ <br /> Cate • (ftarrised n3401 <br />