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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P')425-257-8810 f FAX 425-257-8857 I,(E)ev eps yer.e� o I www.everettwa,gt (p m <br /> i tri+ r'M tttl+ iiC i[k Ol Please ' :-' a 1-- <br /> PROJECT SITE ADDRESS: 2Dt - ,e <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlsuty€ttvltlign <br /> hitt No.:__ (attach copy of long legal description) <br /> OWNER NAME: ni , •V <br /> n M TENANT NAME If Cotttnercta(): <br /> OWt MAILING ADDRESS; STREET (...C)i <br /> STATE Wili ZIP I <br /> OWNER <br /> .PHONE: 425 31104 2510 <br /> OWNER EMAIL;_:; <br /> CONTRACTOR NAME: Cirri i D ` C Inc <br /> CONTRACTOR ADDRESS: �� <br /> STREET II+ -.. +tO <br /> t. <br /> eL ZIP: t1. 1J <br /> CONTRACTOR PHONE: <br /> �6 0560 CONTRACTOR EMAit <br /> -r4Piettl i- e.1st... atih -RET't`"BU$1NES$1 tC s #(REQuIRE+ ` a'? t. ' <br /> PRIMARY CONTACT: ❑OWNER t+ <br /> �t71�TRACT!~aF& 0 OTHER(Please Specify), <br /> CONTACT NAMET,,`,�c,� <br /> Le, <br /> LTJ CONTA T PHONE: L 2,5 25 <br /> CONTACT EMAIL: ' Lk <br /> a� "0 0 CJZ:ttli <br /> 'Existing,Use of BOilditi,: <br /> COntra4t Price of Work:"'$ `J 0 <br /> ixd Use of Build <br /> Heat Source: 04 as; 0Electric <br /> 0C),,ttt _ <br /> FR Detached IJS R4ttached e C _d.sl. UMFt ' of Units: ❑Commercial ❑Inuia — <br /> Typo of Project, DNew OAddition ❑Remodel OR, e- <br /> f*SCRIPTION OP W: plat-Q.r ,'.k ❑T.i. 13$171 ❑ prit [ler ODemolition ) F i e of Use <br /> ASSOCIATED BUILDING PERMIT#(if 4 plic bl ); <br /> 1 eCitaA titdALg ';E!'t1,4'!t'1 A #141 ` �M ' '' ' ry'"--- "--- --a <br /> 4.t h -' ¢�zs ;� M*1N .> i Ill, <br /> Type of Project New Addn Alteration _Repair ...• � <br /> of Type of Project New _Addn Alteration _Repair <br /> s '. #tyo�f }sJ J1 f <br /> Fixtures _ . .. <br /> Air 8 .litt9JstaPTotiet Ui <br /> nter(inside dForced Air S stems Unit"Heate8tttttUrinal <br /> ! <br /> tis Pi*,i. a Bt}#lek <br /> Water Heater Refs _,t ;5h { sh astn rtoo oiznt in <br /> Gas Fteep ace <br /> sod <br /> StoveFlobr Ista <br /> Gad RanI. <br /> �a m <br /> � . eta Sink&Disposal' ;" tar e Tt <br /> Duct rr o Dis�eher <br /> •ham.{: et H QJ Pa Cth ' Roar Drains `. _ I <br /> Ran>e Hood DI+?t s "ash6t" Medlt3 Gas W <br /> Exhaust Fan <br /> WatfkrHeater, <br /> sink Other <br /> - {*a ZiceilEla�Pl <br /> SP'R114SUPP:t 8 ON M ,' '. <br /> Chemical or Water No,of Heads " f <br /> ACKNOWLEDGEMENT:I have reviewed this application end 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.I am the owner,or tam 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 /> 1PERfvll . - <br /> City Everett Official Use Ort?' <br /> Ow WAtithvrtza4A11.• Slggature " �' `��V J <br /> [Yate, <br /> iftvfted.st voit3/ <br />