|
PERMIT APPLICATION
<br /> BUILDING? MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION
<br /> r CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 J FAX 425-257-8557 I(E)av tt sr tre[ettwa.gov I www•everettwa.gov/permits
<br /> til ::'s 1 tsek lutea " Pietas-e;
<br /> 4.1 ikItCYc���'I"�. "_gam' ,:• m . � �
<br /> PROJECT SITE ADDRESS:
<br /> . : , 1"
<br /> LEGAL for new construction: Short?Iat/st.thdt rlai�tix :: PROPERTY TAX ff:
<br /> No,' (attach copy of long legal description)
<br /> ' 6.0144`Ab ` o MAtioN,, „..k,1,--,:,..--:.,171 ,-14,,,,;,:..-,:,,,';,-
<br /> OWNER NAME: 0 1 a=”
<br /> TENANT NAME If`Cort eT0441),1
<br /> OWNER MAILING ADDRESS, °
<br /> e"s. litj STATE ,AR ZIP OWNER PHONE; .'.
<br /> 41N.---------,
<br /> �4WNER EMAIL: :
<br /> ."
<br /> CONTRACTOR NAME:
<br /> tic.
<br /> CONTRACTOR ADDRESS;
<br /> snzEEr ... Pr'.- ,.
<br /> •ctry et, 4', ,,: w'
<br /> STATE - A 14''' ztP
<br /> CONTRACTOR PHONE, ' ' " w .
<br /> � � �,' ;CONTRACTOR EMAIL `-° - sal. V `.
<br /> gk1EQUIRE t R ;,,,gam <.
<br /> PRIMARY CONTACT: 0 OWNER Ili ' ' ' f
<br /> -----
<br /> PRIMARY
<br /> ❑OTHER(Please Specify).
<br /> GCtN"ACT NAME:
<br /> "Delolo L.L. CONTACT PHONE: 25 2:01 0-ow
<br /> CONTACT EMAIL o '` .
<br /> ;•„ % g d 1 ° i.'.� '5-:',4;7'...=','... 7 .17r.:.
<br /> Esdsttno Use of Ei (diril C
<br /> Contract Price of Work: '
<br /> . d use oftFfdint:
<br /> �� Haat Source: '4 ❑Electric ❑Other
<br /> Buitdit..T os: F t- c a a I 1 "A '
<br /> 1piex ❑PACIitt Fa of 1ztia:
<br /> FptaofProject QNew (]Addition CJRemcdei ❑ s ❑Commercial ❑Industrie!
<br /> ft aJr ❑T°t. CI8t� S e
<br /> DESCRIPTION:O 'WORK: o '& {�r ❑DemoliEion OCha,j -rof.Usa
<br /> -
<br /> ..........
<br /> `►t<.!)4a✓ti. Gi\s .4.1 9_Q. -
<br /> ASSOCIATED BUILDING PERMIT�p#0f ptica�A#ait r ,
<br /> ;',..'Mee
<br /> ` . I I+ 1'1.iI�II' �VII Y dt1, .».
<br /> Typ6r.of Project New� Addn Alteration � � ��
<br /> Repair Type of Project. New,
<br /> Addn
<br /> • , a. • #�Y� Alteration `Repair
<br /> ,M0 •,
<br /> #of
<br /> ' *tom- r Nandtt }RttS }eat
<br /> Pip
<br /> Forced Air S : tams Toilet
<br /> Unit Heater a a_# f i ; item
<br /> Pip€n a � ti'
<br /> Wier
<br /> FloorDiaTo
<br /> �a�_ � '. Shower
<br /> rlt Fountain
<br /> cttri. it salt sirktt&:* °* a1 allnii
<br /> � tsa eta �x t ishwaaher `eS Tea.,
<br /> MIMI Re Other: M Etna
<br /> wan d CO es y,fir MO Oar Gasatmum Water Htr. + tr,
<br /> sinktse .'colaarihro.lf o;1 ate
<br /> Chemical or Water
<br /> No.of Heads nIIIIMINMIRIIIIINlallIlaill
<br /> ACKNOWLEDGEMENT:f have reviewed this application end confirm the information contained herein is true and correct.Work done pursuant to this permit must cc
<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 writin
<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 for which apol alio with
<br /> and t comply with the Slate Contractors Law 18.27 RCW and 296.200A WAC" 9 from the
<br /> n Is moos,
<br /> 404/Everett Official Use r
<br /> 0W AutftatlzecC,Ag• Fgnaturq
<br /> vz P�2, OAC {
<br /> r1uVu011: 4a1,6).
<br />
|