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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)425-25,7:881_0 FAX 425-257-8857 1(E)everetteps rer a1 I y,.everettwa,gpv#pe [t <br /> Iliac e�C'Blelck t � iv .,. k <br /> PROJECT SITE ADDRESS "' <br /> LEGAL for new construction: Short i'iat/subdivision PROPERTY TAX#: <br /> Lot No (attach copy of long legal descr(ption) <br /> CaN1AcTJNFOR ;i .,k <br /> t)WNER.NAME. <br /> ..jr Yl'N CI TENANT NAME it Commercial): <br /> CANNER MAILING ADDRESS: STREET 3501. 6' , <br /> er <br /> CITY 'elP,/;" STATE ZIP "' <br /> ._.. � ,. <br /> AC <br /> OWNER PHONE: +r <br /> ' .=°. 72 4r,it"40_4 DiiftYER EMAIL: <br /> r t?CT:RACTOR NAME: ; <br /> C'" <br /> TRADToR ADDRESS: STREET #4 <br /> cm, _ a <br /> COtatRCCiR PHON CI- 611e155C)� •� STATEzo <br /> G INTRACTOtt EMAIL: Erlevrt <br /> • <br /> —_ COti-TRACTNRckE-##REQUIRE <br /> eat° r1.- Crsit4t?S�°•'uDetsE'#(REtztttt i. s , <br /> PRIMARY CONTACT: D OWNERtr- <br /> rOCii "RACTOR0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE. <br /> L7t TACT!MAIL:diir.4atp Lig CC) <br /> gi <br /> Eidson! Use of Bulrtti .; <br /> Contract Price of Work•: " dP +-.Q <br /> 'Pr•. ed Use of Buitdtil,,,,. <br /> Tp !,:SFR-Detached Heat Source: ra ❑Electric DOther e <br /> Ct R tta >&I IAD .lex D+fut#(-Fath 4, of Units;, <br /> T' ofPro edt;,°New ❑Addition ❑Remodel DR..air []T.I Df•n ❑Commercial ❑Industrial <br /> DESCRIPTION OF WORK: D•,rtrti r CI ❑Charim of Use <br /> tSeplek-V2.4,— t. ll -ttarA tc e, <br /> ASSOCIATED BUILDING PERMIT# at,Realm* <br /> IVIECHA141t;AL;;PERMItt OtitiCiktititt <br /> Typo, of Project _„^New Addn _Alteration ,Repair <br /> of: tTtte Type of Project _New __Addn _Alteration „Repair <br /> #Of <br /> NC—Air Randal Units` ��st-fifer <br /> Heal`POinp. Totlet <br /> Fenced Air S stems. Unit Heater Uicrw Preventer,it d R#ci• <br /> �� '• • �atflb � Urinal inare� <br /> Ba her Lavat•;; ' ash Basin <br /> 1111111411 Gas RFac •� Wt Stnll,. • •°at <br /> Pa <br /> tntetnWater t�teBrit ration: Shower FioorDrain Itchen. D Grease <br /> Otothe'€t3 z.,:44i°1°1-Ps' D a: Dishwasher Roof Drams <br /> Rangy=1-F Clothes Washer edit Gas <br /> Rif eater <br /> Other: <br /> e ca/Barl o•/ato. Other <br /> Chemical or Water No,of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein Is true and 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.lam 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 296.200A WAC. <br /> City of Everett Official Use Only <br /> er1Alttherized Age Signature PEj�gA #� <br /> Dale <br /> 10evlre'rt 9723!20/6` <br />