|
'Op,
<br /> PERMIT APPLICATION
<br /> /At BUILDING/ MECHANICAL/PLUMBING/SIGN (SPRINKLER(DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 9820i
<br /> yds yF y j'�q g �y(#yM�.W425-257 8810 I FAX'4'25-257-8857 I(E)event# s i a .gpr� a rettwa.gtsvipera its
<br /> .4 /;+1Ue' efiliatc,Y tif.,P10,fRi g k=,1 ((¢A .... i; ,■y acgrit ,2 4
<br /> PROJECT SITE ADDRESS: f
<br /> 4,101., .. PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plattsubdivislon
<br /> Lot No.` (attach copy of long Iega1 descrlpllon)
<br /> to. ;tk'ri�e. 9` i ty si
<br /> OWNER NAME: 4arl h
<br /> i- TENANT NAME( `Cotttttler•c{sI),
<br /> OWNER MAILING ADDRESS: 3 I5 ,�
<br /> STREET f Ta
<br /> CITY
<br /> •
<br /> TATE' -
<br /> S ‘4114/44
<br /> .... ... . � ZIP ,
<br /> OWNER PHONE: • , 9° OWNER EMAIL:.
<br /> CONTRACTOR NAME;
<br /> CONTRACTOR ADDRESS, STREET +j
<br /> p^� A �' STATE
<br /> 41:g
<br /> , t
<br /> CITY
<br /> ziP g'4 f
<br /> CONTRRACT&R PHONE: Ct ` ,
<br /> (.D GOIfTRACTOR.EMAI 's_di 40 ., .i► ./.4" "•` o to.• 5 4
<br /> 4 CO
<br /> '` "•• a-.` 1, - =I# ss
<br /> F , ` �'-* ilfia 1Ne3StiCel"-a '' ars t*
<br /> PRIMARY CONTACT: ID OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAM L CONTACT PHONE:
<br /> CONTACT EMAIL: ,
<br /> .-'I r*.:.� �,.�,�''� � � z Y to � _.: . �.c,111 •. 4�. #C, *. c .
<br /> *stlrta:Use of Build-Int'
<br /> Contract Price of Work:$ '" ite ttP
<br /> Pro p 4sed Use of'But di,'t Heat Source: 3,!a as ❑Electric ❑Other
<br /> tttltttft• Ti,e: FR Detached ❑SFR-Attached li
<br /> t �teX ❑Multi-Fatrill,=te'ofl�'nC�sd ❑Commercial ❑Industrial
<br /> T,pa of Pm t:. ❑New ❑Addition ❑Remodel DRs&air OT.f• OSit: Os inkier DDemolitipn GnQ inl of Use
<br /> DESCRIPTION OF WORK:
<br /> n t H GF CAS w�r, GAS ,,��€ O M M-e-r�.R ,-o G
<br /> Asst C'tA1ED BUILDING PERMIT#(Ifatjaticable i` -
<br /> M >f ' �`^ �j
<br /> [� ply^- •.y `7
<br /> 14I4I'. e �I�I itAftlt ; ICI ' t ArPi4A -. 'ii.". d• 7f %�Jh
<br /> w S
<br /> Type of Project: New t6bsa+�
<br /> Addy _Alteration ,Repair 7 •
<br /> #vt` _Type of Project: New _,Addn _Alteration _Repair
<br /> 1et7C#ure Li of Flt€E # t #of
<br /> natures •zf•+tkW4-s , ststfPi frr}1r# #of
<br /> �G Air t^tettd{t� �rtiC;k F�r - _:fY�rhrrae,� _ °"",�$ �-brf+r+r� --.
<br /> g Heat Pump Toilet Backflow Preventer Inside-Rl4
<br /> 'FOreed ed Air aids Unit kteater
<br /> Gas Pi a' dol ae L UMW._
<br /> Wafer Heater L i dy,(lVfash Bastrt
<br /> Refit eratl a Shower ► �tTrain ntarn
<br /> as• irsp VVGrfd Move .: ` Floor Crain
<br /> ,4,
<br /> Gas Firept bra Sink&D1 .®sal Grease T.r74*
<br /> Daptlfr.
<br /> Otot es 0 :er Hooktr.s ' welter Rr d T ,
<br /> Other:
<br /> Ran d e Hood aaa ser tori ��"�
<br /> r*It st Fan { a i ther ::
<br /> Sink OlarviceiBeriMehtetc4 O• :
<br /> SP MNKl *r ,JPP
<br /> I "M" Mme'
<br /> Chemical or Water No.of Heads '
<br /> `A t(N tfa r-"t haye tr srtawed tlxfa er atta#71ora ond'orobo ttrr-tftromfattot noniefneefienen 1S hoe end, tYet*Miele done 1;wrsuent•tc dtils intenff nwst,5`ont with
<br /> B hear Det fi rm;d� ,alis rn Meu�raer raig of a Permit theca.eepr vcd work erg etr cTaefehle is there i a TAWa$ns thee(mret stl
<br /> acrd ffno a»,y etretn nster►vd I ere.the ewnet,.crf amartth ('O' ed P i arming do e
<br /> +r>Pfrir l the Shea cheheeters LOW fit2?r.�#CW end 29ts 20f Oad yflirt owner prepet#}r7?pa!#fp+m(a taartr tit ala at29 si 1tr=rir tt;
<br /> •
<br /> City of Everett Official Use Q#14#..
<br /> IPERMIa
<br /> T O(/ V
<br /> Ow er!Atthorized Ag S irtatura Gate
<br /> heves . Otte
<br />
|