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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 l FAX 425-257-8857 (E a (( gov www everettwa vovW emits <br /> (Br coil B a;~ '-l�Wr>f!" Pl at <br /> PROJECT SITE ADDRESS: - �� � � �� �� ��'�� <br /> 5 A Lcri4 band PROPERTY TAX#: <br /> �E.faf1;L for new construction: Short Piat/subdivislon _ <br /> Lqt No• (attach copy of long legal description) <br /> OWNER NAME: A. CONT*03$FOR tOtr - A , <br /> TENANT NAME (f Commercra , <br /> OWNER MAILING,ADDRESS:` <br /> srREEr "� <br /> � �: Lovv�(xc `A. <br /> OWNER PRONE: ZIP Iii <br /> OW <br /> qZ5 232 74q . . <br /> OWNER EMAIL;., <br /> CONTRACTOR NAME, Aii ,, ` <br /> CONTRACTOR ADDRESS: STR0 <br /> ,,A° " <br /> c)aEET .. <br /> ...-, CIN now..< �_ <,,,SrCONTRACTOR PHONE C STATE : zlP, <br /> ° A1C Ot <br /> PRIMARY CONTACT: ❑OWNER t e <br /> i: t� RACTO 0 OTHER(Please Specify) �- <br /> CONTAC`t`NAME: <br /> CONTACT PHONE <br /> e,A,^ r <br /> rid.: <br /> CONTAO EMAIL <br /> atm'= Use of Sutla l4 ill3lf i}� .,-11,10.4•11:1a r t <br /> PPdserr_Use of Suildl, Contract Price of Work:$ _ <br /> • <br /> BU .!T409` ., 0ete9he t OMulti--Pa tin of nits:rce: ®!_to iii erci <br /> �S�R ttac�iac� CID m c �f).- <br /> T . :of Pro t ❑New C7Addition s. <br /> ❑Remodel ion tmercial ❑Itsdustrlal <br /> DESCRIPTION OF WORK I 8�11[P 077,1. 75i®rl , <br /> rimier ❑Demolition IICtlati+ of Use <br /> fa;ni r <br /> ASSOCIATED BUILDING PERMIT# Ifa.oli ;iat0 <br /> TYr of Project _New 1 ,tion `v b'{+ ,, 1'r`� �t T-10,4,* iNGc§. � <br /> Addn Alteration __Repair Type of Project: t �er►New Addn Alteration _Repair <br /> a—Arr Handl <br /> o T - Flx#tuorfe.s ' senrrfotsid <br /> B 11111Morced Air w. nee' Unit Heater ik#dY <br /> 11.11111111,09111,0111 <br /> BIM Waiter Heater a #er avato ash sirs' <br /> alailli Gas - e !ars Shower goo iOrPenni* <br /> rA* r#-# tO Floor. <br /> �a' ttcFtetr Sfsr r <br /> ao �g Imo <br /> _ <br /> cher eio es Weaker #ffe <br /> elGas <br /> NOM h«a:taed Water Ham- <br /> MIR <br /> '- er:xha ��e��to: Wiserr <br /> Mini ' <br /> , <br /> E - Iii ' 2$ IfSIiI1N SYSTEM ti,1,. <br /> Chemical or Water <br /> No.of Heads <br /> `ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein Is true'end correct.Work done pursuant to <br /> ith <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be this authorized in writing from the <br /> Building Oficial before being authorized under any circumstance.1 am the owner,ort am authorized by the owner of this property to perform the work for which applicationyis made <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> of Everett Official Use Only <br /> i .. _ti �•2j•iM. PT �� _ � <br /> i <br /> erfAulotizet€ :rgrretur <br /> Data <br />