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PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> a 'a` CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 t FAX 425-257-8857 I.IEE overottepst Daren. <br /> i IEl:trt !'.`� = ittr� tlst tfrrttxvlstat�tts <br /> PROJECT SITE ADDRESSt as ,d <br /> ` PROPERTY TAX#, <br /> LEGAL for new construction: Short PtatJs Itill;fo' o <br /> tot-No.� <br /> (attach copy of long legal description) <br /> OWNER NAME: <br /> '( . <br /> ���J�,"'. °C' ART.NAME(If Co►Timerctal). <br /> OWNER MAILING ADDRESS: sTReEr <br /> ' w ( ,��Y <br /> cnv ! r <br /> r'° A- STATE ,.4 ZIP IN <br /> cWWNER PHONE: , ,fir �. <br /> ..: r' OWNEREMAILr <br /> CONTRACTOR NAME; id xro , , 0+ VIC <br /> CONTRACTOR ADDRESS: j <br /> STREET 1�4:' BM��6 <br /> .... CITY qnst.. °; .. _. " `.... <br /> STATE ;, ZIP >X ° • ! <br /> CONTRACTOR PHONE:' a <br /> CONTRACTOR EMAIL <br /> gai <br /> -F441MARY CONTACT: 0 OWNER i <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME/:�-� <br /> Y+L/WeJ ='CONTACT PHONE: +2S zscif c <br /> CONTACT EMAILairt.re cot, r <br /> ' BUIL l ��F Sry2'. <br /> n <br /> . . <br /> Existing Use ofBulldfrtgf <br /> Contract Price of Work:$ o ;' ,diP o <br /> PM``ttsapl.Use of Bullet ;_: .�,.. <br /> rfl ®'I'°d•e: �' FR-Detached ❑5FR-Attached ODuplex <br /> Source: ❑Gas ��� ��y: DOther <br /> - Duglax C"Ifvltrlti-Tamil 4 of Units;. ❑Commercial Dlndustrial <br /> Type of Project: CI aw, DAddition []Remodel 01443.air DT,I. ❑Start .IS0rinkier ❑Demolition CJChah,: of Use <br /> DESCRIPTION OF WORK: <br /> Insic t f <br /> prkeekci,tit) i 0 t <br /> ASSOCIATED.BUILDING PERMITif applicahle), <br /> ,..MlwCi}fAlrlIC (t. <br /> aA /P8 n'APPtictitiou , . M,.. -q.. P IIMBI$+G ► <br /> A r" ° �'type of Project: _New dd <br /> ` nAlteration _Repair ,Typa of ProjectNov; Addn Alteration <br /> on Repairof <br /> _.' f�il�ras–— #of �_ #of <br /> zttrtl*s #of "�Ecrt"I�Ixttr <br /> NC–Air Ft�trrtillt�e Units Heat pump �Fixtures �n�_ <br /> Ford Air;,S toms' Toilet f�ow,Preverr fields Bkl., <br /> Gas Pipt � Unit Heater Bathtub Urinal <br /> Water Heater s tiler for <br /> I ava a. . ash Basin , <br /> Rel - an hewer . rtttirn <br /> Gas o =ce {[y�; � F a. 0�irt <br /> eo Stove` 4 tchetx Ink: ;Die,'mai <br /> . ,e Duc{i WI., Dishwasher _ � 3 t` a <br /> loth : _rH cu.a -, Other f+o AlGrains .., , <br /> Cane Hood Clothes Washer Medica" as <br /> E ttallst.Farr Water"Heater" Other: <br /> Sink.Serirti e ..sate o . <br /> SPRINKLE tS PPRESS, N••SYST . <br /> Chemical or Water <br /> No.of Heads <br /> `ACKNOWLEDGEMENT::I have reviewed this application and confirm the information contained herein is true end correct.Work done pursuant to this permit must comply 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 writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,orf am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the Slate Contractors Law 18.27 RCW and 296.200,4 WAC. <br /> City of Everett Official Use OnIlf <br /> �� g PERMIT , <br /> b er6Attlhorized Ag,• Si,gttatttre r <br /> Date .k., InsVIsad ate) <br />