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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER /E�EMOLfT10N <br /> CITY OF EVERETT PfRMIT SERVICFS <br /> '�`=rr���.R �-TREEl 1 ` r rfi� i T lNA 98201 <br /> .�', a'1� 151 f3$1U � FAx 41 �i% �Sh�r ��L everetirt �.YevNrettwa. ov tiwwoeve�r�ttard- ov1 <br /> '1 9 � 9 pennits <br /> Blus or Black Ink Oni Please� PROJECT $ITE INFORMATION <br /> PROJECT SITE ADDRESS _�f - - <br /> '� �ti�-'_ " �-t�.-' PROPERTY TAX#: (�� �' � � <br /> LEGAL�oi n�v co�siruction Snon P�aLsut,o��r;�,�n ,,� <br /> � - -----�--_._-_._--- ' t8ttach COpy r�l!Ony I�.11 dPSC�ipttOn� <br /> CONTACT INFORMATION <br /> OWNER NAME: � - TENANT NAME(If Commerclal): <br /> OWNER MAILING ADDRESS: •,�N�:� / r � ,Z � 1 <br /> �.:r, <br /> — �,r�ie .•��, L� <br /> OWNER PHONE: 1�, 2 '� — � OWNER EMAIL: L(r � � <br /> � (' �'L� - <br /> � CONTRACTOR NAME N ( ��S ,(� I C—� S <br /> CONTRACTOR ADDRESS <br /> --- ° -�-� �_�d�S; <br /> _�.�F�_.�� -_ l.�t _A- �'r 8��� <br /> CONTRACTOR PHONE: �Z�j �5�j���._ CONTRACTOR EMAIL. �(/['(�'� <br /> q�{ L-G� O L ,�� <br /> CONTRACTOR UCENSF q��; ;,�;;it; !;: l°1I �-S��6�� l�i � CITY OF EVERETT BUSINESS LICENSE N(REpUIRED�: 3 <br /> PRIMARY CONTACT_ UWNER ❑Ct��N1kAC,7tlR `�,1{)TfiER iPleasr.S <br /> — pecify) <br /> ... , —---- <br /> CQNTACT NAME: CONTACT PHONE ��•�: Z7J( � � �.� <br /> l�iA.LI v� � ,/ .�--= l <br /> � �� N �, � ' �, �CC?hfTACT EMAIL � I\ . ? <br /> i� 1 \' (� - <br /> �UILOING RERMIT APPLICATION <br /> E+nst�n Use of Bu�lUmq �Gontract Price t+4 'v�ork. f Q� i' <br /> Pro sed Use of Buddm Heat Source ❑Gas ❑Electnc ❑Other <br /> Buddm T pe ❑SFR-Detached ❑SFR-Attached ❑Du lex �Mutti-Famil -iR of Unrts <br /> ❑Commerc�al ❑Indu9tnal <br /> T of Pro ec�t �New C7Addition ❑Remodel ORe alr ❑T I ❑S n ❑S nnkler ODemoliUon ❑Chan e o!Use <br /> DE3CRIPTION OF WORK: <br /> �v�s�t 11 n��-.IU,�ir� ����^"�,Y�'' <br /> ASSOCIATED BUILDING PERMIT M I�f a I�cabfei v <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type pt PrO�ect: _New _ Addn AltsraTlo� __Repnlr 7ype of Pro�Oc' Now AcfAn _AReration Repalr <br /> M o/ ...--�Y o/ � -. . -__ �oI -- <br /> Ffrtures ��st o/F/xtures Lrsr of FinurBs �°� L/st o/Hxturoa Ust oI Fixfures <br /> Flrtui�s F/rtuies F��� <br /> A/C-Au Handli Unrta Heai Pump Todet Backflow Preventer�Inside BI ) <br /> Forced Air S stems Unit Heater Bathtub Unnel <br /> Gas P� �n Boller Lavato lWash Basm Dnnkin Fountain <br /> Water Heater Refn eraUon Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> ras Ran e Dud�n Dishwasher Roof Drains <br /> Cluthes D er Hooku s Other Cloth�i9 Washer N{ed�cal Gas <br /> Ran e Hood Water Heeter Other <br /> Fxhdust Fan Sink Serv�ce/BadMo etc Other <br /> $PRINKLER /8UPPRES310N 3iYSTEM <br /> ChemiCal or Water No ot Heads <br /> qCKNOWLEDGEMENi �nev�rev�ewe<7 m�•e apN,rabon nrW conArm ino�n�omiehon contamed Aerem u nue nnn ro��rt Wo�h dwre pursuenf to Mrs r�e����•,,,,s!compyy wiM <br /> current/aderbr sr,�ro ann�ocel law The pranpnp d e permif onry sutM�nzes�ppip��k end no d�wefiona Me�rlro�, i�s„dnons must hrat bs suthon,ewr;��,5nt�ng/rt�m Ihe <br /> &u�kYnp Omc,ei ae�ore eeNnp aumonzsd undsr eny a�cumstence �em Me ownei or�em authonzed Oy!he owner o/m�s�boNeity ro penorm me wort;ror whrch e�ucannr,�c marle <br /> and I compry wrth , Stete Confiscfors Lsw f B T7 RCW enC 29ti 2AOA WAC <br /> � Gfy ol£veroft OKr�al use Only <br /> � / � % PERMIT� � ���� / � <br /> � <br /> � u�f ' , ���- .� �' v <br /> Own�NA oHzed AqMt gl ture Date (Revrsed 8r23r2pt61 � <br /> � <br /> 1 <br /> �/� <br />