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I <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> • - CITY OF EVERETTPERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)oyer . #elierettoritordeI wwwetrerettl ,(10i1pe <br /> PROJECT SITE ADDRESS: ., <br /> IAEG�A1-for new construction: Short Ftvjatull PROPERTY TAX#. <br /> Leat No. (attach copy of long legal description) <br /> GINNER,NAME a + `.' IIAII"#� • <br /> " 'E 4 TENANT NAME fit Commerci: <br /> OWNER MAILING ADDRESS: STREET <br /> ci?v tires r. <br /> STATE, A z1P <br /> OWNek PHONE: <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> ONTRACTOR'ADDRESS: <br /> srR=6r yy <br /> 1 - <br /> CONTRACTOR PHONE STATE ZIP ,,,, <br /> . .., Q CONTRACTOR ` , ,' <br /> Com. _,. .. TCEf ai „fid -�- s : +N <br /> PRIMARY CONTACT: 3ksdais,.;`,.t�` „- lS 1�tE4E` t�tJ ); � so,it.. <br /> 0 OWNER to ° Tt}I: 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> D„+_�_ CONTACT PHONE G� ZS�J CONTACT EMAIL , <br /> ��g � ...a £$�2� � ;°� :DI �1' Eya ly,.r � �� <br /> Exist'" Use of "Nt-,,ti•e:V �., RMpAp°, s $. , ,f--.� lf';', � ° <br /> convect Price of Work '" '^'"" <br /> Use of Bu1[d#nt= ->. <br /> Proposed <br /> •,I Heat Source: k,:: ..as ❑Electric DOther <br /> St R•C7r eD <br /> d SEt 1:::1I tr lM ❑MUItI i amll 4 of Units: <br /> T -of. +rp tt�,Di w DAddition, DRemodel 0r ( Industrial <br /> DESCRIPTION OF WORK: /; C R pair ❑T.I. I rt7 DemolitioDnGo ❑Chang of <br /> Use <br /> TM& Ce._-- <br /> ASSOCIATED BUILDING��gqyPERMIT ,;y�f a•pirlcabie:; <br /> ';'- ECHHANto- ,PEitkit APPLJCA t1*W' t j t, A`d '' <br /> yp of Project _New �; c, <br /> J Addn Alteration _Repair ' terr ion <br /> Type of Project New <br /> Addn ,Alteration _Repair <br /> ' rtit. ee– .- ..— <br /> #of <br /> NC-.Air hta?'i�{1'tC�l.thitS' Heat Pum Lt;�1t+FdX� m <br /> alni Fort d Air stet s, t _ c#etle+ Preysf r;inside a <br /> y � Unit Heater F.tattx <br /> . <br /> f' oiler Lavat astrO <br /> Inc <br /> GasFoagooliumuntain <br /> jimmuni mater Heater efrt ra n Fuer JoorDrain FIr Alace Wood Stenek s , GTrap O s .t-., IINIMI DvsJ1A rittof rainsa es oku <br /> Other <br /> Illiall <br /> MIIIIIN <br /> Rn. '�c�rstl � allnilin lies ? r ' <br /> x _ Watraa� <br /> Other <br /> �an Gas <br /> ittk :,.IceiSarMo.ittc* WINN a.., <br /> IIMMMEIIIMIIMINIIIIIIIIMIMMIIIIB <br /> "' amssissis. <br /> ,, <br /> a. ` SLR 1' IPiRIIC�lSMY 't"> M_ gF ° <br /> Mill <br /> Chemical or Water <br /> No of Heads <br /> °ACKNOWLEDGEMENT I havee reviewed this application and confirm the Information contained herein is true and correct.Work done pursuant to this permit must complyy with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the <br /> Building Official before being authorized under any circumstance,i am the owner,or I am authorized by the owner of this property to perform the work for which a iica <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> pption is made, <br /> at of Everett Official Use arty <br /> -/3i SO <br /> + er(A ':orized Aye •Slgrttrte t V <br /> pats * ' <br /> PER (O V <br /> >s�S 5 Ia ? <br />