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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER I 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)aferettepsOaarereltwral ppv I www-oar ettwa.9o+1,ilorml#s
<br /> {Etit +t tt,iak°> tl I y Pleas gw -4 , '?F O: t3Ti ...',.-.7
<br /> PROJECT SITE ADDRESS: 4 «_0 rill # if 141L,, a
<br /> LEGAL for new construction: Short Plat/subdivision "� PROPERTY TAX#:
<br /> Let No. (attach copy of long legal description)
<br /> `'CONTA t*I 4�'y .31 ,:l As7 j�' py..*y ,
<br /> OWNER NAME: . . 4 .
<br /> TENANT NAME;itCorrterC€al):
<br /> OWNER MAILING ADDRESS: STREET
<br /> t
<br /> CITY 4 Acle,'... '-•..�f...f, STATE i� ZtF 1
<br /> OWNER PHONE: 0
<br /> OWNER EMAtL
<br /> CONTRACTOR NAME:;
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY 116.` .:."PHONE: STATE'..'! a. ZIP °# ;
<br /> CONTRACTOR1
<br /> .. q 0 0 CONTRACTOR EMAIL 4x,<t! � ;k'i
<br /> '� Alert ,iii ,,t ��CO
<br /> *LTA ow . r y etT is El rentf s3' GLttSe*Rect 1tRE 0 r ;r.
<br /> PRIMARY CONTACT: D OWNER k' CONTRACTOR D OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> T^`w iw CONTACT PHONE. �' 5 25
<br /> �J CONTACT EMAIL: a _ ; '
<br /> ,r}gypi'.;11„0
<br /> �
<br /> EXI@ti '' ,,#, ''',. (,?.!7%:,;,-,.,*, r. a7 ,m, lei ,. 7R ?k PT '. �7 I. t ?., s*"* .., ,r ......
<br /> n8 Use of$uildi '� , .- � $,
<br /> 00
<br /> Contract Price of Work:$ c. ,
<br /> Piz.dt ed Use of Buildin.:
<br /> Heat Source DGas or,t satiric DOther
<br /> DSFR-Attached
<br /> T va of t?ft�'ect: ❑New��©Add �Ou.lex OMuiti-Farrtl€ . of Units: ❑Commercia€ ❑industrial
<br /> E it�T*.T s is: 4ia-,
<br /> ition CFtemodel { Rt,elf ❑T,i, 1SI,n O ;tirlkler DDemolitipn ❑Chi .fe of Use
<br /> DESCRIPTION OF WORK:
<br /> 1YlS1 AA (ip fah
<br /> ASSOCIATED BUILDING PERMIT# If a=tlfcat je), ,
<br /> Type of Project: _Naw AddnAlteration� ' "`���. _
<br /> s
<br /> Repatr Type of Project: New Addn_ `.`AlterationM Repair
<br /> of
<br /> €of #of
<br /> #of
<br /> y r s .._ Jctied tr er - -�..ldtesG— IrNsndl€ , Unita Heat Pump
<br /> Forced Air Systems at Bsnkfltiw Preventer: Unit Heater � Bathtub
<br /> Gas €,. holler Urinal
<br /> Heater Laval' Wash Bain Drtnkt.,`'.Foun(aln,
<br /> Gas Water tee Refrigeratfttt Shower
<br /> Wood Stave kitchen Sin Dia - Floor P�,
<br /> Gas Rahe DOOM*. aI rae ,T �_
<br /> _ Dishwasher
<br /> Re f
<br /> DivineClothes D er Hdskugs .N ' " Clothes-4Yasher Medical-Gas
<br /> e.Hoo Water heater Other:
<br /> , €hatst Fan �k • ea/�ltrf�oaret�, ither:
<br /> Chemical or Water 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,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writingfrom
<br /> Building OMcial before being authorized under any circumstance.I am the owner,or I 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 298.200A WAC. the
<br /> City of Everett Official Use Only
<br /> Ow,etfAv:4— t t# est:-....t itti ,. �� (
<br /> Signature re eat i0
<br /> yr PEiI 1 `gO g " Vim-3
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