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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425 257-8857 E • <br /> {��tali��6�i1��$ir= � �� � t )�� eras.a:_•I www.ay�l,�a4t�cr Its <br /> til.`' , i s _ _ 4 4 <br /> PROJECT SITE ADDRESS z <br /> " : G PffllskRY :GAL <br /> for new construction: Short Platfattaciv isr <br /> Lait No.` (attach copy of long legal description) <br /> y. '0114044 <br /> 0T PIS R 1 , <br /> 2 <br /> OWNER ` .� <br /> NAME. .cJ' • ot� �� �NAN'C"NAME{ Ca�trit`o)� ; -- <br /> OWNER MAILING ADDRESS: al-Rev. .: ' a <br /> • OWNER PHONE. <br /> STATE ,4 .;- Z(?'„� <br /> 5 ZS : a .1” <br /> 'OWNER EMAIL; = <br /> CONNTMOTO1'.NAME: CA ' <br /> C?NTRACTOR ADDRESS: STREET 14415 ti!?1,001,,Atx9. <br /> ci <br /> CONT • CITY ,� ,'. P: , <br /> RACTOR PHONE STATE V �, zi�. <br /> Q: CONTRACTORyy <br /> PRIMARY CONTACT; ❑OWNER eCONTRACTOR ti OTHER(Please Specify)• • <br /> C; NTACT NAME: t <br /> �2.b c.:aCONTACT PHONE <br /> , 425 25 �r <br /> CONTACT EMAIL: ,,s t � " <br /> Ecistt ;Use of: wtt€J ri®a .. . . <br /> . Contract�e.of Work: r . "'� <br /> Is . ..,Use of Build : , - <br /> S+ tdiT .eG1SFR Clatached r« <br /> Heat Source ` es ❑electric ❑Other <br /> ��AttOe edl DDttm9ex Mu(tt tllit: of Units; u <br /> ode of pk• t: :New ❑Addition ❑Remodel ❑ omttaerc( ❑Indu <br /> eJ strial <br /> DESCRIPTION OF Wt Ft#C • <br /> r ❑T'I' ❑ ❑S>rtnkt i� LTDemolition ❑Cha :sof Use• <br /> i .3as tl ,, <br /> a{SPIATED BUILDING PERMIT# I:o,M>li0able <br /> Type of Protech ,_New :10� ' 1 ' <br /> � Addn ,Alteration Repair �,•, � c � dd lt ' <br /> of � _ Type of Project_New _tRepalr <br /> Addn <br /> err .#of *of on <br /> Alteratl <br /> ,. , h it t. tt . ;a ,' X Fixtures <br /> 1dlat . <br /> Forced #t,y tJ Neater•,.. m f Preventer i , Id-a <br /> •e <br /> Water eater . f�• e 2$s!n- s !Fountain <br /> fr:®eros <br /> as ' m lace ` . W � IR' <br /> Move <br /> ,-- .Dst lac ° 'a: �Jr _ eFitoks <br /> Ra Hood <br /> Rxha Hood <br /> M ; <br /> ..,:ate-;ar/Mt?',y c, � <br /> Qfhef <br /> Ittii t S TE <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 donepursuant 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.f am the owner,or!am authorized by the owner of this property to perform the work for which appticatlon fs made,;; <br /> and i comply with(he State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Usa Cin:IV <br /> ' ?- d fPE # <br /> M# <br /> I are -0 Q.(-1:. <br /> i Dale ', 'OfftilSetd.`�, `-- c:...-.. <br />