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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER!DEMOLITION <br /> 001 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ( 425-257-8810 I FAX 425-257-8857 I(E) ei ,.,� <br /> (� or Bjatck 9Ottty Pli r a tri•ROJ E �� e. www.sverettwa goy egr ets <br /> PROJECT SITE ADDRESS: # ,r _' � "- ' •: <br /> LEGAL for new construction: Short(0 �� <br /> Ptatt ,dlvn <br /> LotNo.' PROPoEp ofY longAX g: <br /> (attachlegal description) <br /> fIt �v y��t�+ 4";1:0141t$?; <br /> y �--' <br /> COTA r INP• ° `es?rr ,.A; y t <br /> 'OWNER <br /> A ' a I. TENANT NAME"t#ttortlnretota ; <br /> OWNER MAILING ADDRESS; srt:Eer1 <br /> t <br /> CITY <br /> OWNER PHONE. 10 4 IA STATEe <br /> > ZIP as 3 <br /> a:..t9teL.# . " OWNEREMAIL: <br /> " ,: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: srnErrr r C6 <br /> caY v.. ;s ' IF #p <br /> STATE ": zipdgr ":$ f <br /> CONTRACTOR PHONE CONTRACTOR EMA °. ; <br /> . OR• Lt+CEIVEErI�q?jkE3t 0"0,"g 11 0 .Co <br /> tl# , <br /> 3gtl :. w ee <br /> PRIMARY CONTACT: ❑OWNER � � „`�0e �•-, Fx <br /> 3ACFQ 0 OTHER(Please Specify) _ <br /> CONTACT NAME, <br /> °DeJelt/J Leo , <br /> CONTACT PHONE: 426 2.51 OeeD <br /> CONTACT EMAIL , a S_ _ CO <br /> ,' -�ti1t €bl :�T ;-.`l., 0. 7- a s ,,o r x Vie'.. <br /> tixi;(;ttn Use of B ` �X "� , t,- <br /> dna Contract Price of Work:$ . <br /> Proposed Use of B ildirt <br /> Heat Source: OGas `moi jec'ittd. DOther <br /> Sttjitlle'= T . I_ I�`-Detached QSF DO <br /> OfOuttt attlit 4 of Units: ❑Commercial Dindustrial <br /> ,TA* of Pro °❑New DAddition DRemo.el ORetieir DT,I. D lgn g inkier ❑Demolition EICha <br /> ngis':DESCRIPTION OF WORK: 9of Use <br /> lh� a tocc„ 1- iP do s - rt,t,ce, <br /> ASSOCIATED BUILDING PERMIT# f a...feeble <br /> ` "1ylM CH'.. IC:AL.�PE M111.-APP I:CA P <br /> Type of Project ,New �"' TItD���� '� xk �" g s.,,a �� � 1�119�1 ' c.�� - ;'.�" <br /> Addn _Alteration Repair <br /> kw iterA <br /> �'•of � ., � � ,' #of Type of Project _New _Addn Alteration _Repair <br /> - ea 'ttfll?8s #of . <br /> �� fsQ trine <br /> ori Air S -14419 Batth t- 13ae t�f P errier <br /> Ung Heater Bathtub aide Bid. <br /> Gas 124/41..1IMIIIIIMMIIMMIllis <br /> Water Heater .Lauesa Ah; Sint " r . ; <br /> < it Shower �atdCEstn <br /> Gas. tri Wo�i�Stove P°. ,�" � <br /> Gas Ran. Ouuctin. Dishwasher 14I,tt hen Sink S.else. almenimmimm <br /> s Ra e y okit•s .: : = <br /> Clher: Rod'*te <br /> = _,s Hood �hoe ' <br /> lri Des' <br /> star t . <br /> Other:Fan" MIIIIIIIIMIIIIIIIII Sink Ser�t'' tY t)• etc. Other: <br /> PRII KLER t tJpPRE $1ON$YS'N`E1% <br /> Chemical or WaterNMI No.of HeadsIMMMIIIIIIIIIIIIIIIIIIIIII <br /> ACKNOWLEDGEMENT.I have reviewed this application end confirm the information contained herein is true and correct.Work done pursuant to this permit must comply <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,ori am authorized by the owner of this properly to perform the work for which application n is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WA C. <br /> pity of Everett Official Use Only <br /> r 1. <br /> taaw-erfAitfttbriaadfit, � jPERMIT ( 2O� <br /> Ag-• Signature <br /> (Rev/sod �1 <br />