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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)
<br /> ,
<br /> eve t a4 +l yo everatt i`�r ittr, jis as{Buttkf l } t N
<br /> PROJECT SITE ADDRESS: ¶ f4 Oe .fir •
<br /> LEGAL for new construction: Short Ptalfpfdn PROPERTY TAX#:
<br /> �pi��i X No. ��(attach copy of long legal description)
<br /> r; +coN AM ,i<'1141.$--.' A1)ONl +, 5 t t A'
<br /> OWNER NAME.
<br /> i TENANT NAME(If CotrtstaOrolat
<br /> OWNIER MAILING ADDRESS; t . t
<br /> STREET .�, o1 . ct.
<br /> CITY QQ °,,,, o
<br /> a'�" � ,0 STATE ZIP - . W
<br /> OWNER PHONE: o5 _ OWNER IttL:
<br /> CONTRACTOR NAME CM )4eickMil in C.
<br /> CONTRACTOR ADDRESS: /�..y
<br /> _ STREET �s. G:/ w _.
<br /> ( STATE L` = ZIP - I
<br /> CONTRACTOR PHONE 1 '
<br /> � � O CONTRACTOR EIs1At1
<br /> c.ENBE f(441r 1i1lisP}:eek 'tWi '' ':;
<br /> PRIMAR1t CONTACT O OWNER h CONTRA! {FR 0 OTHER(Please Specify) R f[ . , II. ".
<br /> CONTACT NAME: ,^,11,^���,,��
<br /> � J L� CONTACT PHONE: 2,6 zs? D55t)
<br /> CONTACT• EMAIL: ,
<br /> --r-- ' 4 ,Zin lL #I E 1f1' tal�i llitlll ll, ,gip
<br /> xi-sting Use of Cuikllr
<br /> — — , Contract Price of Work:$ 5 y_,
<br /> Prn.osect Use of Builriln o:
<br /> Building Type: SFR-Detached ❑SFR-Attached OOu Heat Source: ':Gas DElectric ❑Other _
<br /> 'k =e of Rr. x C Multi FFrnil - of Units,:
<br /> A ec.: ONew (]Addition ❑Remodel ClrinkIer ❑Demolitt C DCh n Chndustrial
<br /> �i#Il ❑T,i, CJlO
<br /> DESCRIPTION OF Wf�kIC;. � � ftn�o of Use
<br /> Ruin 90.5 el pi,� --Fr) ra,Te firef)Ictcji. ci-- 5ep
<br /> jASSOCIATED BUILDING PERMIT#[If ap.Plicablelt -
<br /> Vii + I+111.:, RIitA0. 3E:i(S'I"+1 <.,
<br /> Type of Project: _New Addn Alteration Repair
<br /> 1:t of Type of Protect: New _Addn _Alteration Repair
<br /> �txnaa- t s #of
<br /> �#s101'
<br /> ?xttl� "--""1"44•�u, #of of
<br /> Haf��tltri• t trlt< ., l lrtt'ures, 1 'B+f 3xfurp
<br /> Heat Pump • Fixtures
<br /> ''—,3 Air '-tams •Toilet ,
<br /> Unit Heater Urinal P"rYelttsr.(inside;ljd )
<br /> Gas Pipits -Bathtub'
<br /> Bo ler' tmy(Wash Basha tjr nki
<br /> Water Heater Flim Fountain
<br /> I has Flrelevo � =era�orl.. Shower ', � a
<br /> Wood Stove Kitchen Silk&O osal -Grease
<br /> Drain
<br /> Gas �e :: . .. Ore Trap
<br /> Oue(itt. 'Dishwasher
<br /> CI-gibes 0 HookuNe Other: . """' of Ott
<br /> Rane Hood � ., E�lothes� usher Meryl Gas
<br /> f< test ran Water Dieter Other ,
<br /> ..,. . �. 1Stpk'(Ber ice ar/p/etc) Other:
<br /> "$PRINKI.ER/SUPPREss4oN SYS 11114"",,;.
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT:t 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,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,t am the owner;or!am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State Contractors Law 18,27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only'
<br /> PERMIT#
<br /> fps'_� 0la.�g.i 1 . 01\'l ( 17
<br /> et/Atttr►or►sr t g_. Signature- Date;
<br /> (Revised�:�I?"s�j
<br />
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