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<br /> 0011111W PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettepsaeversterieu(oe I Vivinm.everettwa4Civiliarrnits
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<br /> PROJECT SITE ADDRESS: - a k 1 - PftOPEIITY TAX#:
<br /> IP 144C4) , , ,
<br /> 'LEGAL for new constructin_n: Short filattsubdkitorf, ot No. (attach copy of long legal description)
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<br /> OWNER NAME: '44M1111011111:4.,'Olt._ .,,4 ..... , TENANT NAME(If 001111110rOia
<br /> pyiittER MAILING ADDRESS: STREET • .- .,,,# , L_,,,,,," e-' ,
<br /> 017, 7/1
<br /> STATE ZIP
<br /> OWNER PHONE: • , OWNER EMAIL:
<br /> 3 - 2:1‘), '
<br /> CONTRACTOR NAME; Ai I
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<br /> CONTRACTOR ADDRESS: STREET 1 4• 0c4Laulist
<br /> . STAN , ZIP
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<br /> CONTFtAtTTOR PHONE: LV'-'1. C.)' , .. CONTRACTOR EMAIL'o, a 4 i 111' ,141 •) 0, iS le//A .C.
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<br /> - - NII;t4WT4akiAtCENSE4$01EQUifirt40---..IA 11.0";,;.'s- -:.'"" %Imo 1,,, nessan'oPeveRerrtusINEstriceNtiM'Agqt1H‘eril. 15
<br /> FRIMARY CONTACT: 1:1 OWNER t' CONTRACTOR 0 OTHER(Please Specify)
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<br /> CONTACT NAME:
<br /> CONTACT PHONE 245 2.0' f.47.-a-vc?
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<br /> CONTACT EMAIL: ' a . , 0,-, co
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<br /> E)cistio. Use of 13(11101ri.„*...'
<br /> Contract Price of Work:$ _.,&_401A--.
<br /> Pro.()seri of Use Suildln!:
<br /> eat Sot.irce: *-',1 Gas CI Electric DOther
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<br /> aufidi t 00:‘ li:SFEk-D: 0., eci I:ISFH-Attached OS i.teX CIMUltf-Farnil 4 of Units: ClComniartlat OlndustrIal
<br /> T,.s of Pr.., h 1:7.11Jew 1:1AcidItion EIRemocIel Merair, CiT.I. OSI! OS# inkier ODemolition EIChan.e•of Use
<br /> DESCRIPTION OF%MORK: v . • f
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<br /> ASSOCIATED BUILDING PERMIT#.
<br /> MEC
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<br /> MEC' ' 1 'r'- 'llitititlit,45,00.''."-- •,;ti. ,,e,-,,,,t1-; ' Ff:"‘",'-'1';,;',,•-,t?f'4,4:0i0:1:1,1046$4" ,'".• 44fili I '''':,r11,L• *,OHe-'
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<br /> Tifpe of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair
<br /> Of ter illpigliMillirM #of #of
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<br /> NOAir/10nd' Units
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<br /> Heat P . T t NMI;eckflow'Pretrenter inside
<br /> ForceciAtt ‘.terns fillam unit- aster 'BatrilotY Mai urinal
<br /> Gas PI.i ! 411111n Sailer ' LalratO :Wash BasinNMI Orinki ,.=Fountain "
<br /> Water'..-giter' Una Raft!oration Shower IIIIIMIN lar a =In
<br /> re late o..Stove Kitchen Sitlk&Oitt..--; min Grease
<br /> Gee Ren?,,-, MOO 4 1:110hWatitter 0111M1 Roof Oreins
<br /> OlOthee o - '110* .s OWN Other , Cl -,her _____Medical('as
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<br /> Ra !et Read 11.11111111_#(1Mmism Water -,,,"'.= - _____ Other
<br /> E*ha.st Fen 11111111111111M111111111.1 sink SentioeMarittio.eh,Nogg Other
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<br /> Chemical or Water iNo.of Heads I=
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<br /> OeMllOt rederet,litate,sad kicaf fa#.7fle,.gtanffauota perti41.0a4t4140tizttsapjoPtaal visilk'andno deAtionsthettitibtit.-Of/Y./at/0*s mixst Ik41 be titittifilizOdllifaititto ktirn the
<br /> IRAVd140 011icietbWete.bekt47 eutilctized tot'idet any041milutonco,1 emli*-omm.qri vn atitticlittni by the DT6f till O PtoPettY 41 Pt4ttbom flit!tvo f*kr104t,i4h-opilifoittipp is-ssedo,
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<br /> City of Everett Official Use Only
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<br /> Ow' rfAuthoritioa At Signature ' Date
<br /> !,, (13evisert9/23/2016)
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