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et_ 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 425-257-885T I( 1 averagapeilleyarattyea,see I www.everettwa.gov/permits <br /> A(itHite ar 1c'i kIOhtyy fii$asc ., i' IttVt p W <br /> PROJECT SITE ADDRESS: PROPERTY <br /> TY <br /> ° ROPE <br /> R TAX#. <br /> i. GAL for new construction Short Plat/subdivision Lot No." (attach copy of long legal description) <br /> CONT TO�. �N°o-`'i R� . -0,-.?..7,.',', <br /> OWNER NAME ' _, <br /> 'e TENANT NAME If`Corntfrercial): <br /> OWNER MAILING ADDRESS: 0' <br /> srrxEr;r �, `: 1 m w ",• <br /> CITY t .4 <br /> STATE <br /> OWNER PHONE <br /> OWNER EMAIL: <br /> CONTRACTOR NAME <br /> r <br /> CONTRACTOR ADDRESS: STREET 14 <br /> CITY... 9. i - .. <br /> .::..;: STATE <br /> ZIP <br /> CONTRACTOR PHONE <br /> 0 CONTRACTOR EMAIL: > 4 f 1a$ P 0'-'I * res- <br /> CC P,. , s tR 1, *till A �Pm -01*ViE * ,,; «t.';' P `r 4*. <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR. 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> ^ t^ <br /> '^ CONTACT PHONE 2.5 05 <br /> �J CONTACT EMAIL: <br /> �'(r ?- BttILbir,4 c '• da m <br /> Exlstint Use ofBulini, <br /> Contract Price of Work:$ <br /> 'Pro..sed Use <br /> Heat Source X44_as C1Electric ❑Other <br /> I3ufidi m Ta` <br /> � ,"-betaohed ❑SFR Attached 013u.lex ClMutri(rar it 4o U €e <br /> Type ofPro { p►IeUV pAddition ❑Remodel .C] ]Commerciat Olndusnal <br /> DESCRIPTION OF WORK` OT'I' OSS, QS1litlkler ❑Demolition [�fha of Uss <br /> i YtS+ I Get S a � c aS I/111*e- <br /> ASSOCIATED BUILDING PERMIT Itt. If app)if « , <br /> _ cType of Project _New Addn Alteration legimmi,Repair Type of Project New <br /> inewfiffwgiiiiAddn Alteration Repair <br /> Kris <br /> for. <br /> NCNUM 'Air i^i, cfilrt• ,samattaamowsimissemie Heat}tarn; MIN Toflet xtt s <br /> ralllimil F+ e Ail''S Stems unit 1feater; Bathtub t low Preventer tstd a, <br /> Gas Ping <br /> Boll er <br /> man R , •ertt _ T88 =' 111111111111111111tklrtg Fountain <br /> C <br /> I^it lace Shake 111111111 Floor Dtaift <br /> Vkibud Stov1a- NNW1 vtert Siitlk&.e r . <br /> lin+ Drs 'e: e <br /> CIO O rHookups <br /> tiff' ins <br /> other:,' ,clot washer asher <br /> IfcsodalliMIt� diI =s <br /> MEM xhat� e <br /> s`eeSetUfe atet�s,J other: , <br /> F NNNIIIININIIIIIIIINNNIIIIINNI <br /> 11111111 Chemical or Water <br /> No.of Heads iminimmormilanismisimmi, <br /> ACKNOWLEDGEMENT..I have reviewed this application and confine the information contained herein Is true and carrect.Work donepursuant to this permit must comply 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.1 am the owner,ort am authorized by the owner of this property to perfonn the work for which application is made <br /> and t comply with the State Contractors Law 18.27 RCW and 295.200A WAC. <br /> City of Everett Official Use Only,,. <br /> 1 �. 3_ � <br /> PER <br /> Sign tore `+., ' i, l — 0� <br /> YJAiitfttor(;BL k 'Signature ai <br /> t]tte ), McVised 016) <br />