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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBiNG!SIGN /SPRINKLER/DEMOLITtON
<br /> CITY OF EVERETT PERMIT SERVICES '
<br /> 3200 CEDAR STREET,EVERETT,WA 982U1
<br /> �P)425 257 88'f 0 � FAX 425-257-6857 l�E)�erEy��{��q�������� �yyvyy.everetiwa,�s,a+��+���y��
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<br /> ��J�CT SITE ADDRESS: ��- ���'�;���.
<br /> , ��� PROPEF�TY TAX#:
<br /> ���+AL for new construction: Short Plat/su6divislon
<br /> . Cot No.° (attach copy of long lagal description)
<br /> OWNER � �� ,} '��'r �`���r���"�����`� �' , -��.r E ���aA` ���'
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<br /> NAME: . , r .
<br /> � r� TENANT NAME (fCat�[t��t���t�;
<br /> t�i����MAILING ADDRESS:. srrtEer �( 'rJ" ,
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<br /> , �OWI�ER����Il�#1t�.k„
<br /> CONTRACTQR NAME: � '. .Y1�,. . :: , -
<br /> GQtd`t`t�'iC'�`(�R ADDRE85 ,
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<br /> CONTRACTOR PHONE:
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<br /> ��,1�`�!�•'�t��-�t�M����t3t��,�' : � ,
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<br /> P'RIMARY CONTACT: ❑OWNER CONTRACTOR ��� ������������������ ��
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<br /> ❑OTHER(Please Specify}
<br /> �ONi'ACT NAME: ; _.
<br /> � _ ��N7'ACT PHONE:
<br /> �2ki�c�¢. . �5 25 �� `
<br /> GONTACT EMAtI � ��,
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<br /> . � ..,,,- _ � Cs. 4't ;- ,ex&< '. . _` - , .
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<br /> � � Use,of Bt�i(d � �, � _ .< .. .. „ .
<br /> � ` _ C€��tra�f price of Work.$ ,,�`; � „�
<br /> ►tt� e:
<br /> F"i°��St�s+�sf Use of�t�il� „ �
<br /> Heat Source. ❑Gas �,������� {���.
<br /> �c�I�flr� 7" �: ��=�etached ,C75��Att�cf�"�f Ctl�u Isx CIl4��t{�Fat�� »�of t�ni, -
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<br /> �»nta�tci�l ❑Industrlal
<br /> T •e nfl�r�i�c��`[7New OAddition ❑Remodef �IV�� �ii` ❑T.I.. ��� �4 �5 ,ir�(�fet' ❑Demplifion �I�Fr.� of Use
<br /> ' pESCRIPTION OF WORK:� _ _
<br /> _ _ .
<br /> �2�C2 J1.1�2.(�{'6"r�G �1jr►�GtG£.
<br /> ASSOCIATED BU�LDING PEBMfT� �,�" ������';� , '''
<br /> ,, .. r���iif�`a��{ Y#.., ., ., ,:.
<br /> .. #'�A���F+����1;�1���F.��.t����, f�l ;'aL J � ,�. � .�5: ,+� g v.:.:: .
<br /> .�' �s'� ��� ��wf������! '�
<br /> ' "x"� •::�. .3 '" .,
<br /> Typ�oF project _„T,New,�„� Addn Alteratton _,Repalr ° '� '�`
<br /> ��f Type of Pro)aet• �New _Addn piteratlon Repalr
<br /> <�.:: �'+�1 !�a/
<br /> ...�..����x��:��.".'"`"....'._. �� �,��. ,�. #of
<br /> ' � �� fi�iitt � .. 4 �
<br /> AlC—Air�#�r�d!►ri 4.�i���:- Hsat'��amp� ` ��s y ��t€�s. �ts�����I�k���•�_.m::..�..
<br /> �o�cstl A�r SY.ste�� T�i#�� �6�i��t�+�w Pr��ntQr 1r��i����(
<br /> Untt F���r ��kh�.►t�
<br /> � G�ass FE`in � � �t�ikee �� �JC��f�
<br /> ' Water Heater : �'��. ������t :. `: tlt�tt��t Fountain
<br /> sFtr�i` lace ���r�fic��t' Sh�c+�r ' ��oarC�raln
<br /> Gas t t g - �'�s�t Stove ' f�itct��t�5it�k& 4s ��f: ��r�s�T�^�
<br /> � . �tot�ie�t7 �r'FI€�oku � �7uctlr� Dl�f�ti4��#�r �t��E3ca7�s ;
<br /> � e ����: �ra�n�����t�:
<br /> Ft�n e Nood �C�Gas
<br /> Exha�,st Fan : 1N'�ter€3��ter ` Other;:::
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<br /> � _ �nK ��'+�Ic�art�f �#�.= Qt����_ _
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<br /> ` `=����M1+�i��IER=���P�". �_,.F .a�, _ ;
<br /> ��R�+�il�a S'Y��"I�i1�t � _
<br /> Chemical or Water ' "
<br /> _ No.of Heads
<br /> _ _ ;
<br /> `ACKNOWLEDGEMENT:!have reviewed thls appllcafion and con/!mt lhe lnfonrref/pn con(elned heie/n ts hua gnd conecL Worlt done pursuanf to ihJs perm/t musf comply with
<br /> curren(federal,slale,and/oca!law.The granling of e permi(only aufhorizes approved work and no devlafJorts therefrom.Devlallons must tlrst be authorized!n wnttng fram fhe
<br /> 8uffdfng Of(!claf before befng authorlled under any circumstance.t am the owner,or!am aufhorized by!he owner of fhls properfy to perform fhe work for which applicef�on is rrrade,
<br /> and f compty wi(h the Sfafe Confracfors Law 1b,27 RCW and 296.200A WAC.
<br /> ,
<br /> RS��:oJ Eueielf OMcial t/se 4��9ijdt>
<br /> ^�� � �� ° PERMIT
<br /> � ���������� �� � �_c� 6����,
<br /> �Ipi�ature _ _
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