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PERMIT APPLICATION
<br /> BUILDING/ MECHANICAL/PLUMBING I SIGN/SPRINKLER/DEMOLITION
<br /> .,, CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 i FAX 425,257-8857:1(E)everett p arettwa,gov www.everettwa gevtper ..
<br /> I�Ifal ieSlack Bili. .til 'Pleat 4 q
<br /> PROJECT SITE ADDRESS � ��
<br /> i
<br /> t"'. „ ni 4 PROPERTY TAX#
<br /> Ai.for new construction: Short,, 1 �`
<br /> Ptttti.0' 10, artst
<br /> I tt€No ` (attach copy of long legal description)
<br /> A of I `, i n4,g A 'fqp �i
<br /> OWNER NAME, > � �
<br /> " TENANT NAME SII Commed #
<br /> OWNER MAILING ADDRESS: STREET
<br /> c1TY..
<br /> �yy lE STATE W ZIP `A" .�, f:'
<br /> OWNER PHONE a. •_; ''„`t, ,,:a , -
<br /> OWNER EMAIL;
<br /> CONTRACTOR NAME:.. - n c..
<br /> CONTRACTORADDRESS:
<br /> STREET14 -
<br /> CITY •
<br /> , , ,� = V..
<br /> STATE ZIP" A CONTRACTOR PHONE:. a C
<br /> OONTfti
<br /> - le) , 41' ,"- tVtf<ftITT
<br /> PRIMARY CONTACT: 1:::1 OWNER ler L � a "(?a {r. + "
<br /> DO AUTAtC T NAME:
<br /> CONT- OR, 0 OTHER(Please Specify) .
<br /> ��,^CA CONTACT PHONE � CJ ZS
<br /> CONTACT EMAIL Ilei,
<br /> ,4,,,,,,4,10444:01-010:- _I'tz;A' 1 0 1
<br /> so.°.Use of Sttlttll s ;Inv,a��:'c.i a ,
<br /> ., Contract Price of Work: r r
<br /> Prop Use of _«
<br /> Ruti�In F Source: CIGas p Other
<br /> FR, todhed.. EISFR Attached D
<br /> tstx.'"ONew OAddition ❑Remodel CIlsaftrttrtfty. ofl
<br /> 't+ .-''of F't= it- ,,. ❑Commercial C7lndustrial
<br /> ,DESCRIPTION OF WORK: _ ®`il' L7T.t• #°n 134"inkier ❑Demolition. Ct3$te ti,of Use
<br /> 1i E1ett''rt( V Wait IfIfttaktr
<br /> ASSODIATEb BUILDING��. PERMIT#' t.,a a((e fr ,
<br /> � 64 .
<br /> ',M ';OER�.Mit ii IeAlli347` ,: ''.9 -/"A Mit PYzifg % ...
<br /> Type,d; Project New Addn _Alteration _Repair s
<br /> t `4'4',"g"'"or 7 • #of Type of Project New ,Addn Alteration _Repair
<br /> #/ .: `' -a
<br /> MINI! AirNandllq'Q Urtt ${ ,
<br /> " FJartttne >
<br /> MIME ForcedAPl�, tAs r
<br /> J �i`. t Heater Ib t33cfjtari Ptavenler,Inside Sf€f
<br /> arillalliZatar
<br /> *, mortal
<br /> '° _ tk` t''trtt' ' '. main
<br /> `" $txt; Shower
<br /> I= �. t e . Pltrrof rsie'"
<br /> Gas 'e 7s 5or 8a a_''ase et ',
<br /> Ocl a i3r
<br /> I�<,''''S
<br /> s.* erI`ioktim-
<br /> "Re a� ted MOM h.e- ROilf Me ns
<br /> _MININtot d, to
<br /> mono�h�Fdn a e- e f
<br /> t ': -a Q e Cote'
<br /> .,, '1,1418*-' WILE- 1SUPP1 ES$1Cl NSV`$TElVl i*r,
<br /> 0,10,1Ic or Water No.of Heads
<br /> 'ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein Is true and correct. Work dons pursuant to this permit must compl with
<br /> current federal,stale,and local law.The granting of a permit only authorizes approved work and no deviations therefrom,Deviations must first be authorized in wnfing from the
<br /> Building Official before being authorized under any circumstance.i em the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the Stale Contractors Law 18.27 RCW end 296.200A WAC.
<br /> ,ty`ofEverett Official Use Only
<br /> PERM T* „ t •
<br /> Ca/gtt3ltirlsed+ SfI iura
<br /> Date L. », -
<br />
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