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00400. PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> -a CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 ].(e)Avetetl+tpseetferettv�ra; osf i www.everettwa.gov/permits <br /> El iu oel laa s kp d Ple `, a:.,pRoji 51 tts' f 4SITE ADDRESS: e x <br /> PROJECT SITE �� � <br /> x PROPERTY TAX#: <br /> LEGAL for new construction: Short tVaubdivislee <br /> Let No: (attach copy of long legal description) <br /> OWNER NAME: V'j; s t ,. . . , <br /> �{ i'I..I TENANT NAME It Commercial):, <br /> OWNER MAILING ADDRESS: STREET 1 <br /> CITY sea„ A` s <br /> STATE W ... g 201 <br /> OWN:»fit PHONE: L2S 31555405' ziP ' <br /> . OWNER EMAIL;_ <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 14 41 octzt449 4$ <br /> CITY srATEis ,01 <br /> T V ZIP <br /> La-I <br /> CONTRACTOR PHONE . .05SC 'CONTRACTOR EMAIL . <br /> PRIMARY CONTACT: 0 OWNER ta,' CONTRACTOR <br /> !R 0OTHER(Please Specify) <br /> CONTACT NAME: <br /> T�_,_ s_ CONTACT PHONE: ,4,," G zSti <br /> —, �J . Ot+4TACT EMAIL' t e <br /> t € ': C trli <br /> F,Aistiem. Use of Build! I; <br /> Contract Price of Work $ - �,., 79 o 4 <br /> Pro*osed Use of Solidi <br /> Bttl(tflrig Heat Source: Gas ❑Electric ❑Other <br /> F -Detached ❑S� 4ttached °Mole ❑Multi-Fanill of Units - --l <br /> T ',-of Pr•o`-°•.:; ❑New ❑Ad¢ition El Remodel ❑ CI-Commercial ❑Industria <br /> DESCRIPTION OF WORK: RsRair ❑T'I• ❑S°n ° ' alar ❑Demolition ©Gf1an»a of Use <br /> ! Lt -tztnKIcs�s vsja h a- <br /> ASsoCIATEQ,BUILDING PERMIT# ifapp(jbie'' , <br /> T or Project: ^t•05ri f. <br /> _New ` Addn ,^Alteration _Repair � ` <br /> #ef #o f Type of Project: New `Addn Alteration Repatr <br /> , ,. �tct #of <br /> A/C–Air Hartdttn. rail . Heattkar. :�41s - er r <br /> ,.terra toet <br /> Ui HeelerBankfi ti Pre�tertfer to l Sic* <br /> Forced Air S <br /> a I�ip?c�.; Bathtub• Urinal. <br /> Butler L vafo, gait Basin" ' <br /> Water� eo'er C?rirt . <br /> Refr,f erati , Shower r FtatrtTt <br /> Gas ' .ace Wood Stove Floor Drain <br /> t es aKitchen Sink&Di sa Asa Grease T } <br /> L uct n: a ' cher <br /> Clothes 0 �r.Hookups 0: Other, Roof Drains <br /> G <br /> Rs t*e Plood Clothes Washer her: s <br /> Exhaust iron ter Other <br /> Sink Service/Barikeleiei 0 :r <br /> ........l+lI Eta SU PRESsio slf : ,'' '''TE <br /> Chemical or Water <br /> No.of Heads <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 /> current federal,slate,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 f am the owner,ort am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW end 296.200A WAC. <br /> City of Everett Official Use 004, <br /> atsif#rrstNrrettA signature3.j g PERV Vkk. ibh0( ... og <br /> ... , -:ted /20,0 <br />