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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I'(E)*V Ct p .oe �40u I www4etir'e�t th <br /> $R I Bl . k$flkk' tflty P eas 'ato <br /> PROJECT SITE ADDRESS: 2 <br /> .LEGAL for new construction: Short i�tdtfsu�tlMteion � r ' PROPERTY 7AX#: <br /> lotNa.' (attach copy of tong legal description) <br /> i'i <br /> 0w�3'tNAME:. Or- 'TENANT NAME{(`Commdrelat); <br /> OWNER MAILING ADDRESS; sTREEr a•• " <br /> STATE �'it <br /> 2" ' . ZIP . <br /> OWNER PHONE: <br /> � OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> coNtRACTOR ADDRESS: /� <br /> - <br /> STREET ` �4+1..� <br /> CONTRACTOR PHONE C) STATE ( ziP dr <br /> �. <br /> PRIMARY CONTACT: 0 OWNER t;. <br /> ptaTR 0 OTHER(Please Specify) <br /> CON'fA 'NAME: <br /> Tt <br /> L Le, PHONE: .5. 2 ,- si <br /> CONTACT EMAIL <br /> Coe <br /> �lr r i x a <br /> Existl : Use of �{ '� k <br /> Aldi,A c °a 3� e' fi. <br /> Contract Price of WorkF. ,.. <br /> PrrsPined:Use of SWlldl . <br /> utfd * T , eatSource: ,. ['Electric as Electric ❑Other <br /> 4 � FR-Detatheti 1SFR Attac ert ClDe o lex '❑Ntulli:Faml1'-#of I int% <br /> 14.0 of Pro est: CI New ['Addition ['Remodel p m o ['Commercial ❑Industrial <br /> ,. . fr ❑T.I. ❑ 1•r3e iter. <br /> l of Pro t OF WORK: «c 0.0moll �n.a of Use <br /> q.5 <br /> ASSOCIATED BUILDING PERMIT# <br /> if'a..rffceble; <br /> Type of Project New j Addn ��� °; t <br /> Alteration `Rep <br /> air Type of Project _New Addn <br /> � -, — _Alteration _Repair <br /> ..fps #of <br /> C-Atr1fancfltn i14c ie"-Pi`-- f -kb(:. <br /> its Heat Fum o . e <br /> Forced r -Wig Toilet t parrs <br /> 11111.1 Whit Heater Etat b oirtai Ft ilertter .Irtsfc- til®r <br /> Gas F?ldt � *`I81^ t.ttit�al <br /> MIIIIPMIEMMZ ' Shiaveaval°r i�;l3 ssit MOM!"! F rural ri <br /> MIMI Gas Ei =loos Re,.± #io�1 �ttct�rd� <br /> Wood St ' t tet'a t &i s <br /> +�rrr Gln <br /> c `•; >=sort <br /> C� Hood£ s: .MIN Other. Dishwasher m <br /> T ..r, <br /> MIMI <br /> NNW .41t a Ochmedical Gas <br /> Exhaust Fan11111.1 fl aor Other-; <br /> sink Sant rtivia 0.ete Other: <br /> Chemical or Water NM No:of Heads <br /> ACKNOWLEDGEMENT 1 have reviewed this application and confirm the information contained herein Is true and correcl <br /> h <br /> current federal,stale,and local law.The granting of a permit only authorizes approved work end no deviations therefrom Ward done Dumont to this <br /> Building Official before being authorized under any circumstance.I am the owner,ort am authorized by the owner of this property to perform the work foreearn* <br /> h application Must comply yis made, <br /> and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. Deviations rJrr{t1ff be authorized in writing from the <br /> • <br /> Cllr.of Everett Official UseOral <br /> a0„.41211 ", 0,....„_, a�r'A `PER I • <br /> �:.: txecf -19estere Date <br /> 2O.j r <br /> r i , <br /> ° e t <br /> fR Bit iT 312016) <br />