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PERMIT APPLICATION
<br /> , � BUILDINGI,MECHANICAL I PLUMBING I SIGN/SPRINKLER I DEMOLITIONxositri ,
<br /> CITY OE EVERETT PERMIT SERVICES
<br /> '{ 3200 CEDAR STREET;EVERETT,WA 98201
<br /> .4t25 257-8810} I E 4425-257-8857 I(E.) everettwagov j v ettere tw8.g permits
<br /> :; ,
<br /> PROJECT SITE ADDRESS: Y PROPERTY TAX :' 7-Ey-ell O 8 3.1 531)-()141C) 3 o.
<br /> LEGAL for new construction: Short Platfs dirision , Leu rio (dada,copy of long legal description)
<br /> OWNER r tAnnE: `- i L L TENANT NAME cif Care e1 cial)x
<br /> OWNER N1A LING AI717R@SS:;: einem' , , •
<br /> I 7 1 Z II O . At w
<br /> OWNER PHONE Nis. OWNER ENIAI 4
<br /> tOAITRAC'TOR i E + t,st 0 Pt �; ' � eta,;
<br /> CONTRACTOR ADDRESS: ente=r / t `_'
<br /> CONTRACTOR PHONE: 2 0(p. + -1 s CONTRACTOR EMAIL. re %: Jrca 4 "„` v®,IR
<br /> CO NTRACTOR LICEI+SE#Real rtED);P R e I PhtB-t' cITr OF VERETt BUSINESSI tcENSE#REQUIRED) 4'. `2 0,
<br /> PRIMARY CONTACT: L')OWNER ll'CONTRACTOR ID OTHER(Please Specify)
<br /> $CONTACT NAME: CONTACT PHONE: " S lc O $t
<br /> t` r'iIC
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<br /> im. ..o- _.� . . .aa . rtr9"*t4,. ue •, e..
<br /> Existing Use of Building: rilAt4- Contract Price.of Vitoria$
<br /> opi�Use of Building: r Gt�;4 _Heat Source1. . ClEte ric CI e,
<br /> Building Type: C ISFR-Detached OSFR,Attached ©pup s °Multi-Family-of Units: . _ _ `` omn `=r t ClIn,¢u riat
<br /> Type of;Project. ©New C7 ""Rddition errrodel 1r, DTI.; CtSign C(Sprinkler Qt arrtaiiti. C Changeof Use
<br /> yDES�RIPTIOIf OF WORK:
<br /> '"`i ''n'ctlr t�' t �� f a, -tarty'Y+ .� 41t. '; # " fi t- 'Lrt+1 , i "� } (^
<br /> 6,I r(V(.141.6till +ri'-itil
<br /> _ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ,. ',4.-u.„/4. ,.
<br /> �� List„
<br /> ofvrAcf,fid t1 oFt T .,
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<br /> . g ,,,pw , ►kIA I � popiA ,, .. .- . —• - -• „
<br /> Type of ProjeotNewAddn _ eratoltn _t ate' Tyr OtP Addti , awLisofFixtures',wares a t
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<br /> NC—Air Handling Units Ht F!umis ; ;; Toilet Backflow�reventer(Inside Bldg)
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<br /> Forced Air System junk Heater Bathtub i1 Urinal
<br /> Gas Piping I t'ler' Lavatory(Wash Basin) l)rinkinc9 Fountain
<br /> Water Heater
<br /> Refrigeration Shower ,Floor grain. ;
<br /> Gas Fireplace Wood Stove Kitchen Sink a Disposal ;Grease Trap
<br /> Gas Range 171 itg Dishwasher Roof Draitrs;
<br /> Clothes Dryer Hookups Other: v Clothes Washer Medical OPRan Hood Water . _. Other;
<br /> Exhaust Fan Sink,(S$ervace/Sarll /etc-j Other:
<br /> 'Chemical or'Water tea of Heads
<br /> ACKNOWLEDGEMENT phare:reviewed this ltppilr;atiorrsndt conlimr the f fount rht tained herein a true and conte irk'dorm.p ,ttol#hrspe t'mustcomplywWi
<br /> cument federat state and local law,me granting eta mongol*aruthorizes approver"Viand. t refrom.Doolatk nsmu ;ffrstbeaut#o m"liege m!tie
<br /> Building Oficial before big eethetized<r�rlcter any e r steaSe.lemma owner,or am authori¢ed by the ownera'this properly perms►thewotlr•for which pplica is leave
<br /> and I comply WO the State col caters Law/8.27 RCW•ene,296.200A WAC:
<br /> City ofEverett Ohrciat Use Only
<br /> .,,o,...._ -- -
<br /> - -�_ 1.1,,, PERMITfl-(o - o.
<br /> owrterfAutltsrfzerl,AgentSlti, tu Date (tlevrsea: : 18)
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