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PERM17 APPLICATId�
<br /> BUILDING/MECHANICAL 1 PLUMBING/StGN i SPRINKLER!DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3240 CEDAR STREET,EVERETT,WA 98201
<br /> (P}425 257 8810 � FAX 42�257-8857 �(E)e��e. , ��r�tl�:��r.� �+w.everettwa,�py,+��[}�
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<br /> PROJECT SITE ADDRESS;-. . ' ' §; `� T
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<br /> LEGAL for naw oonstntction: Short � �������T�#:
<br /> p����������� ' La�t,No.` (attach copy of lang legal descriptlon)
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<br /> CtWN�'R NAME. , , ' -
<br /> ; , TENANT NAME�[�+��rrttrieir�t�t�: __,
<br /> OWNER MAILtNG ADD �: szRE�r . ,'
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<br /> � � � "� � � STA'iE ��a'1:� ZIP..�' � ��w�;�_..
<br /> OWNERPHONE: .,,�� �+�r� �� . ., :�'3Y�ER;ENtAIL:':
<br /> �C?(�TE�A�'TflR NAME; _ `
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<br /> CONTRACTOR ADpRESS: srREer - -
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<br /> � � . STATE > Z(P
<br /> ����k��`C3�t-PHONE; �Q � � CONTRACTOREMAI �. .' , „:
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<br /> PRIMARY CONTACT: ❑OWNER ;,� CONTRACTOR ❑OTHER(Piease Specify) � m
<br /> CONTACT NAME: _
<br /> �^`��A� CONTACT PHONE: ,��CJ ZCJ ���
<br /> �Ci�GL�'J �{D�d�"AGT EMAlL:
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<br /> - Contract Prlce of Wo�k ,� : .�
<br /> Pro,osed Use of��s���" :>
<br /> He�t 5aurce. , , �� ❑Electr(c ❑Other
<br /> �� �a►P�dir���T ���w���tr��` ��I1�-�A,f� �u i�c ❑Mult �
<br /> ' -�� � I-Famt1 �afUnits; �ICommercial ❑industrlal
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<br /> T, sofF�rb t:�'ONew, OAddition �Remodel Q1�. �rt ❑T,�, ❑���� �� �����p� ❑Demotition _OC
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<br /> bESCRIPTtON OF WORK:, hat� e of lJse
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<br /> '� 2,, � - . .' ,:�I' G�C�,S IfZC� (.�141 ,t���� �(�'
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<br /> '�0.SSOCIA7ED BUtLDING PERMIT# i(:�: ���t�:; , °
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<br /> � 3�s���Pro eah � New �� Alteration Re alr� � � � �� � � �� �.
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<br /> � " y J Ype of P�e������c�,
<br /> 1 Addn _ P T ,
<br /> 1�of #�� ^ - 1 _New ,,qddn ,�Alteretlon _Repalr °
<br /> .. ..�., xtu: ��t. #of #of '
<br /> � .x+t'tusS _ flx;tures ��°•--� _-
<br /> Ftsat F�um T�iiE�� ' �ackfiov�F*reventer }j��itf�-�id
<br /> c�r�sst:«�Ir� sto�� r�€���t�r , Ei.attt�tt�b ;
<br /> t3as.PI in `� �Urt�a�
<br /> �tai��� 1�ar�t �1t�h��s,I�t.
<br /> � k�atsr�Heater ��� e ���' �.�in' • � �� _ "t�� €` Fountain �� ;
<br /> � C��"�r ���e �� �raw�� �t�r-�rat� � ;
<br /> Gas��� � kN�ctd.Stove 6Citch�r��in'�'&�Ps c+sa�.
<br /> et�ttss ' . �r��s��'�'
<br /> �lothes ��r`�cs��j�� ��ts�t�r. � : F�k:13C��s. � � _
<br /> ��rs e.f�#oei '; _ G�.�h�r; �lt�t$1�3 :�t�� °''
<br /> � I��ti��I Gas �
<br /> .�3cl���Ist F�tt . �?�tBP t#@2#8�' C���:
<br /> � .: . ���tk �t���el8artt�lo e$�: C?Fh�r.:
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<br /> : �.;°�F�N�+f1'C����;�.'��i'F������t]i��'�'�`�;.. f �,
<br /> Chemicai or Vi/ater ' No.of Heads
<br /> :
<br /> 'ACKNOWLEDGEhfEMT.•!heve reviewed this apppca�ion and eon/frm fhe Informatlon conla/ned herein Is bve and Conect.Work done pursuant lo thts permt�musf compty wlfh
<br /> cumen!federal,slale,and loca!law.The granfing of a permit only aufhorizes epproved work and no devlaffons therefrom.Devfal/ons must flrst be au�horized!n wrrting lrom the
<br /> Bupoing Orylcla/belo�e being authorized under any circumstence.!am Ihe owner,or I am authorized by fhe ownar of thls prope�}y to per�orm(he work�or which appilca(ton Is made,
<br /> end t comply wilh Ihe Stafe Contracfors Law 1g,p7 RCW and 296.200A WAC,
<br /> G777�Cof Evereft 011lclal Use t�
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