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0— PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING l SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT.WA 93231 <br /> (P)425-25T-3313 I FAX 125-25T-a337 <br /> Blue tit", i l i t2 9i� se ! s € tteP a rat t t www.xv r F ave Vx�i kt <br /> R iii �t �l�#I p m t � .v '6. ,. <br /> SITE ADDRESS. _ <br /> LEGOS 0AL PROPERTY TAX f€: <br /> PROJECT <br /> ur�ra��3a,:vcfian, 3 sore Play,•uh3iv:�to;r <br /> l or No.° faftac;h copy of long legal description) <br /> SWR NAm�� �d ..•, �� <br /> 64 TENANT NAME(11 Commercial): <br /> OWNER MAILING ADDR. SS; 1--,--, s• <br /> ,. ilio Alibi " at <br /> �..,d,� �rtr. t <br /> OWNER PHONE; ZJ' i # t <br /> +« )OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: 3r . <br /> CONTRACTOR PHONE> sxTE ' g : 0 <br /> 0 . 0 CONTRACTO EMAI • r <br /> "« 03 }x;= t_' ' � :�� myvterrit <br /> PRIMARY CONTACT: , " ,._ �. <br /> 0 OWNER L CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: <br /> 1)e,t00 t - 2..9% t' ,,�I <br /> CONTACT EMAIL: r •CO. <br /> E,. Use u 1LDtt d �`f e , <br /> o€tuft <br /> din... � _ ,� s�� .� _ - <br /> poe Use of tlitifo., rtsj�tract.Prioa of Work:$ •Jo - <br /> t in> ,: R. .saSa� �w HeaE Source: e3a DEIeotric °Other <br /> sa <br /> Qa QUER A,.ah=d <br /> CI, ult€r a niI: S UniEs: <br /> Yee of t'');-' ''.'s'e„tQNa�,v L7/-4d:iiEian Q;� mad..i Q:����lg. QT i. ., � QCamm,.r,.iat Qind!t;Eriaf <br /> D: 4ItpTfv O F <br /> WORK;',i OS: n © rrs`tkler C 1E7emoiitign• Q-". ' ' of Use <br /> Os tsiSe4-4-- <br /> ASSGClATED S'JMLDtNG PERYifT 0"if aoolt'a*51 'j;., <br /> •of Project: Naw � =xw r <br /> --__ nAlteration °� l <br /> _Repair � � <br /> Add Type of Project- `Naw Addn _A(eratlon <br /> aftativiLta .. l.istot s #of Repair <br /> ism AlC—Airylion #of <br /> aatiil i, units eras <br /> Lxtetre's i�°� <br /> MillNC— Aii Heat Pum <br /> Zcllel <br /> items Urifl Heater " <br /> teas iBathtub ata iorezfter ins" ) <br /> Water Heater" drafte11.11111111111 <br /> r <br /> unimenorraiect" Lavaca:. 'Wash IIri <br /> lisive�aswr e eria Fountatn <br /> allillianinnallelliM Wood Stave shower <br /> innrFloor•rale <br /> IDte fn._ ff�n Sink&COfe.osat resae Trap <br /> �alhas . 1111111111 <br /> er Not ups s a <br /> sher NINIILIEPied,e Hood sadfillitaOther: Clete .er Rosi Irafns <br /> 1111111111111.1 Rao <br /> ood1111111Mwater Heater' inumenMedical lea- <br /> Sink aervic ar oolete, Other <br /> Other <br /> 11.1 <br /> 1111.1111 Chemical or Water <br /> Nc.of Heads <br /> A `NOWLt;:C RdE,/i h1 havereviewed.this eppt caljer asst se <br /> � <br /> t#atr� el4r �tred t•erd:irantgteCt:ersi,istfate,andmkgatlat:w,z°r7readrerrftdttrsCritfwr::40. o .r , rte tvtst�ctv�adfss 5+muusr1a:tL:$#1tui:14411 <br /> el r lwur <br /> ointd& <br /> Xp%ymYN(eLtfar3 t ,with the SiaaCcrraccraLawi 2? kaic t arhevre, :r fop; n � ttlsf3ldAei*ot7ti vahrk`er�sFk aFaer,is <br /> m�es,Caei +o ae <br /> City c1 Everett Cfficisl Use Crfy <br /> 4. Al U fit• 12•ta P - #( <br /> C #rl}trtricarta t:A°+' :° �. _t �� — O SO <br /> SIgnature <br /> I <br /> Coto ' <br /> . .(Rovood 340,t6} <br />