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<br /> BUIL DING I MECHANICAL 1 PLUMBING 1 SIGN 1 SPRINKLER I D.E� •
<br /> F".,, .orr r-c r1-ar r'nr mt.-rutty-ear-14A 4044.4k
<br /> (P)425-257,6010 1 FAX 425,25788.57 4 peveretteps@evorettwa,gov; vNimeverelINa.goviparrnkt
<br /> (Bilge r NV*INA Only.P ' FROARTAITR INFORMATION
<br /> z-,,,,,,7,..!•.,u,--;,„,... '.-.7.-r,_:-:„.LTI-71,,-22,2!=:: 7 vp ev49.41.1eagt..,_ t to1J.1,6'-'-''''!' !-:-'-'----4' .,!
<br /> iLeViAl.for new cortetWiett Short Plat/subdivision Lot`+ .. (a tath copy diang ter,si a rilAort)
<br /> COQ „� INFORMAtION
<br /> 7 iEa 4 fA d... .,L +t.... :...y s-„=* ...-.tw .IA' ,„wx ' .3 iw
<br /> cifilliERii MAILING.4#r» STREET / i^"" ' ' :a` / S' .+ . 6. fAI+..» $ )
<br /> CITY (j STATE' ZIP
<br /> i;1TlLiii4r'r:tbsx 4 x 2 i' t°' 0 I � r y '8 j zl J e i 43. �"/ t
<br /> .3ssetrx.r'k�.flYt�l�.: r
<br /> CO ACTOR NAiNME 14AW 13 1, j. £),JS 4E4"rit1/41 r
<br /> CONTRACTOR ADDRESS: smsEr 770=9 , R Ave.
<br /> ',, 2�T. 0/A. fes s
<br /> TUTOR PSE. 42c*, W pr / 3 MAIt.t 4 Sd 1
<br /> reletTRArTOR 1 le-Psi iP AVM IRPFM. MY riP FVFRPTT R1t..VMFAC t leFfIRF otttPoitutt^n
<br /> PRIMARY CONTACT:+ACT: D3 OWE CONTRAUTOR CONTRACTOR0 OTHER(Ptease Specify)
<br /> CONTACT NAME: ,.
<br /> 'CONTACT PKONE.
<br /> ittIRLDitle PEMPAY APP ICA` `a; ,ia..r
<br /> ����E�9Use of guiding: 111+
<br /> D �mm
<br /> 3.0 luln : tiat r»,..vr..eiach •ra.r -,u.ach iVi . ` Iu ti-Fae€i - o
<br /> Units __....
<br /> Type of Project ONew: ClAddition CIRernodel
<br /> QRepair OT.1: °Sign DSpRinIder Ebernolition QCha�n/ge of Use
<br /> OESCR tOFI OP WORK: PwT /. # st: E
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ig .w.....4 ..r r:. K4 6 :e. . ......�..`....a.*W..` .. t e i."......"* .+.*............,. ."4.,a *0......:a mi. f
<br /> Type of Project: New Addrs __Alteration_,._Repa r Type o o sect: Asoma Alteration Repair
<br /> Ptttsf of Fixtures UStorPlEtures
<br /> Fbttures FFixtures Fixtures List et Fixtures
<br /> i tirrr'�fi.i#sir `�r STAIYem i 1 inn lipatar I i § tlit ill a a rFicel =ir .
<br /> Gas Piping Boiler tevarctry Mash Bashi Drinking Fountain
<br /> Water Heater Rerieraotr ,Shower Floor Train
<br /> I Gas Fireplace .Wood Stove Kitchen Sita&Disposed GreaseTrap
<br /> } l eas ti,.....,,c gLrUs..ca€,0 t,"0...w ae?e t i q+uf',MOH t:
<br /> r .:iotnes Dryer Hookups (Giber: Clothes Water $ 'Medical Gas
<br /> Range Hood Water Ree#w'. Other:
<br /> Exhaust Fan Sink(Servite/Bar7MoPletc.4 Other:
<br /> !Chemical of Water htai of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this app#cetion and contkrn the'activation contained heijt n.ie true and correct.Wor*dam pursuant to this permit must comply with
<br /> ,rye. -.,..-- ,. .. ,.� ... L4;:r .
<br /> Cu sdirro€price# to:e Fng euthb zee:t Liar et/yam/440mtentam ma owner,o tan nu ori e x r the u ovr z #r s em ' .t or i fi,.7 ..«t,,�c tri..A-a o.
<br /> and t comply adtththe State Contrac .Law 18.27liCWand 296200A WAC.
<br /> My of Everett Official Use Ont
<br /> PERMIT
<br /> ., � '
<br /> owneriAutherized Agent Signature Dale (Revised 94212010' .
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