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BUILDING/MECHANICAL�PLUMBING CSIGNN SPRIN
<br /> KLER/DEMQLITION
<br /> ClTY OF EVERETT PERMIt SERt/lCES
<br /> 320Q CEDAR STREET,EVERETT WA 98201
<br /> (P)425 257-6810 ( FAX 425-257 8857 ���}p���gj�����,��r�E[�g -,�, www�q��x�,�p,���,��,
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<br /> L�{�#�:fornew conslruction: Short PlaUsubdivisfon
<br /> 3a�t No.� (attach copy of long fegai descrlptlon)
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<br /> OWNER NAM�� . .,
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<br /> PRlMARY CONTACT: ❑p�/NER CONTRACTOR ❑OTHER(Please Specify) �
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<br /> Ct��fT`i��1"NAME: � CONTACT PHONE:
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<br /> Existi; Use of 8uild! a
<br /> Contract Prvce of Wark�$' , �
<br /> Pr psvd Use of Buildlri ;- ,
<br /> ����d��� � �A �Detached Neat Source: .�s ❑Electr(c, CJOther
<br /> � �o��f��r ext;` �New �Additfon �Remod �d �� �� ❑Muftt Fa�nTt.»,#of t�����, ❑Commsrcial ❑tndustriaf
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<br /> e1 Q� ir ._ .C]T.L �15I h �� riri�ter ❑Demolition OGf�ri e:of Use
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<br /> ' A���?��,�+yy�'�D BUILDING PERMtT# �`�' 1(��o-bl�. ,. '
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<br /> T�peeofProJect: _New _ Addn `q�teratlon _Re afr c
<br /> ��,f. - p Type of ProJect: �New _qdd� plteratlon �Repafr
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<br /> �� �:�tttYr�.^:> �'�" Flxlures "���������Ixfcrt�ac �-_ _
<br /> �—.Atr H��tif?� 1.��til� _ _._,,
<br /> � ��rred Air� ��E�.s t����Purrr : 7`�I[� � � ��� �c��+F�����r�+�?°..#t��i���t'� ��
<br /> d:fn#�Heater ' F'
<br /> �atl��uts
<br /> Gas R���n � ��J�r �#ri�ttat
<br /> � �l�t�r��e��r � L���t�ti ";�, ��h�s�� t��irtkf�i� �Qt�r°��i�r
<br /> ��Ft. ' #r�iti�n �4�rit�r :
<br /> � ��� �!aac�•Stove F1i3e±�:��R
<br /> Gas�' . � �t�ctir�, �I��it�k•�"C�€� �i � ��°��.� �
<br /> � �f�#Fa�s C� er�f�a�kup�: ", rJther: Dishwasher �ae�''�r�t��
<br /> `` � Clafhes: �}�8r:._.
<br /> ��a e:hto� ��cf��i.�� ,-
<br /> �a�a�st��r:i �atsr��t+�r ; f��t�e� _
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<br /> ` �i!'��t�1��«ILR���tI�PRRE$St�1�°�'Y�'�'�14�t:'� a: :
<br /> Chemical ca�i�+�t�t�� �No.of Heads .
<br /> '"ACKNOWLEDGEMENT;l have reviewed this applica(ion and conllrm the fntormaUon contained here/n/s fn�e and eonect,k�✓pr�t dorre�, �
<br /> current faderal,state,and/oCal law.The grantrng of a permif on/y aufhodzes approved work and no dev/a�lons fherefrom.�yJ�lons:�ugt i7�s?6e aulh�rl��t!n writfng fiom fhe
<br /> /7 t���if to th�s.Ferrsstt must compiy wifh
<br /> 8ulfding O�cla(be%re be/ng authorized under any circumsfance.!am the owner,or 1 am aufhorized by the owner ol(his property to perform the work for whlch appilcafton is made,
<br /> and/comply w(fh(he State Contraclors Law 18.27 RCW and 296.200A WAC,
<br /> City of Evereff ONc1al.Usa Qnly
<br /> � PERM{y�#,. � : _ ..
<br /> , l `R-!8 Y`�I �
<br /> uw ap�;�Author�r�a Rq �t�rracure
<br /> ' Dale , � :�eWs�z1�9l2�Qi,6j _
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