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n. <br /> OAP <br /> PERMIT APPLICATION <br /> OivyBUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET EVERETT WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1(E)evar <br /> 1i��`�Ili�i� �l�Ik�$�I!1� �� ffi � � � � etivolgtiv� '��aarf Wwwe4te3e#tvYA9otCittSt"ri#8 <br /> "R S rENlF <br /> Jr $ � 2c a��'�ix��,'k��z.BMs <br /> ,PROJECT SITE ADDRESS; 5 �PROPERTY TAX `x`^` <br /> '` <br /> L # <br /> E�3AL,for new construction. Short Plat/subdivision: <br /> Lot No.' (attach copy of long legal description) <br /> . rC NTA . V1 '° A l P e i.w;Y > "5 <br /> , :;' <br /> OWNER NAME, 1�n '�.1'rl � : ' <br /> OWNER MAILING ADDRESS: STREET6t i TENANT NAME(jf'Coreercjajy <br /> 411, AIC <br /> CITY : r < <br /> OWNER PHONE:.. ai `s • drz a. - sTnTEAir ZIP a <br /> _ g r OWNER EMALL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREETrj <br /> C)� ;# <br /> CITY mir. �° V , _. <br /> ._ :_;. STATE 1ii. ZIP "' r I CONTRACTOR PHONE;, <br /> '� Ll zee+fib CONTRACTOR EMAIL ;„a,.,ft #, , .w <br /> -- CONTRACTO1V4ICENSEAREQUit'itia):-a 'il. ;,, A �+a lib t VeRE <br /> PRIMARY CONTACT: 'I"�`BLIStt��stCEhrSE'IEGStJtFtEt�f' ' o a.C.�� _ <br /> D OWNER M CONTRACTOR D OTHER(Please Specify) <br /> CONTACT,NAME: <br /> 'l,„i,��^ iw <br /> CONTACT PHONE: <br /> x <br /> CONTACT EMAIL. ,_, ,.;®•a o <br /> Etistin•. Use of <br /> t'rn.ctsert Use of ttdfr.; _ <br /> Contract Price of Work:$ 4: , *0 <br /> Rsltldi . '� , Heat Source: � DElectric_ DOther <br /> ROOetacheci CI$FR-Attached °Duplex, DMultl-Famii -it of Units: <br /> T 4e of Pro act DNew ❑Addition L1Remodel - - Commercial ❑Industrial <br /> DESCRIPTION OF WORtC: <br /> Cle.atr OT.i. DlmnOS. <br /> ? tiler [7Demoiition �{�hasaze of Use <br /> 'ASSOCIATED BUILDING PERMIT#(rif,o ,lcable;, . <br /> MiECHt1N[CAeP1"sR1Vl1'li'APO. 4QA. , <br /> TY of Project NewAT ON 7 i rr,?�, ��,4, t 01 ",,. <br /> Addn `AIteratlon ___Repair -`. r I � " <br /> #of #of Alteration of Protect: New Addn Alteration _Repair <br /> aftti� #of' .6_,_______41°f�xf . fixtures <br /> etrO- Atr:HaIjilo Unita Heat Pump Toilet nw F rentei Ot <br /> to BdForcecjAir Systems atub Urinal <br /> Water Heater 11111111110 Roil Ieua ash Basin Don <br /> INEIRIR 111111111W:t1CSIZallmm Nan Refria -Shower Fluor ;a lri <br /> Gas Reri e Ytroad. tou5 _ tdhart Sink p1 ..,.al Grease <br /> trare <br /> Gas <br /> Re D er Hookups ; INNS usti; Dishwasher MIN3r tasa r is <br /> Clothes <br /> Heed Clothes aal r, MRoof Drains as <br /> E:d3ft �Fan -MINIIIIIIH _ <br /> Other <br /> Gas <br /> Sink Sart/lo arJl o ,eto;� Otter: <br /> Ot#aet <br /> PNt+tlt)tlit >E1i !R;I3SFt1 'jf.Tflti <br /> prix_ <br /> inimiiiiiiminirisiinitim <br /> Chemical or Water <br /> 11io,of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein Is true end correct.Work donepursuantbe to thisauthopermitrized mustinwritin comply <br /> from withthe <br /> current federal,stale,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first <br /> Building Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform(he work for which application is <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. 9 <br /> made, <br /> 4: <br /> Cify,of Everett Official Use Only <br /> P I .• <br /> OE it.�— a 1 vZ�j./ �/ r,.b <br /> ow IaFtAuthorlYed'.A 'Eat.ura - CJI./ <br /> Dale <br /> f 0 Seth 912 0/4)' <br />