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PERMIT APPLICATIC11 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ...--• .-- •,:;•,..../...v. <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I ia)a retttPs ftWit.gdv I www.everettwa.gov/permits <br /> (B't e o Bim ik•V ity tlie4aa c'' :., yds{ - - i <br /> PR)JECT SITE ADDRESS: , a 0 <br /> `' �a s . a.3 it PROPERTY TAX#: <br /> LEGAL:for new construction: Short t tisaut5C VIslo11 <br /> LLISNo. (attach copy of long legal description) <br /> 1cON'i•A r O irlONx;t S,i; g 0 -d° <br /> OWNER NAME: Ip <br /> 1 <br /> i`, , TENANT NAME{If Commercial): <br /> OWNER MAILING ADDRESS: STRE=_r <br /> STATE-: '. ZIP ♦ 20 x <br /> OWNER PHONE: «. .*r <br /> 0 t OWNER EMAIL: <br /> CONTRACTOR NAME: Ai A to <br /> CONTRACTOR ADDRESS: STREET <br /> 114 torY241:14,..t.74:2L.A1 <br /> STATE a ZIP dr r . oil1 <br /> CONTRACTOR PHONE: Cl i 0 CONTRACTOR EMAIL <br /> ik 'L ' ' <br /> « ".TtNfFIy AI kjEftwo1 ), -� .. r 4ICtRE1_ � <br /> PRIMARY CONTACT: 0 OWNERrq <br /> IV CONTMOT011 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE. <br /> "I)elato u2, <br /> CONTACT EMAIL (444 <br /> r a 6 « <br /> .1 <br /> , #UkD <br /> Existin. Use of Byildin_; <br /> Contract Price of Work:$ s <br /> Prqqosed Use of Building <br /> Heat Source: {as: ❑ ❑ <br /> Electric Other <br /> Bttlldint, #-: ),:::e FR=I tathed EISFR Attached Ota., _ <br /> OMuttt-Famfl 4of Units; ❑Commercial� ❑Industrial <br /> mgCR PTIONOFF WORK:❑Addition EIRemodel QRepair❑ T T.I. l 111. prinidet� I�C1lemolitiort ©Crienge of Use <br /> i llS G`�L¢SS /Fur <br /> LASSOCIATED BUILDING PERMIT# Ifa•«Iicablo`: <br /> a'� ,' e t: al�tt�u�g� <br /> Type of Protect: New Addn AlterationC1# iC1N " � �. „.�T'#a<i 1C 11 <br /> Repair Type of Project New Addn Alteration� <br /> 0f #of C . ._ tion _Repair <br /> f F�lturus' ra <br /> NC—AirHit Pump Fbrturesfx# f <br /> antilinf Units ('ottel R <br /> ) <br /> Forced Air S tents Unit Heater - #t+c Preventer(inside Rldg <br /> Gas Pi in Bathtuburinal <br /> Boiler Laval <br /> Water Heater A askl.Basinr Drain t i <br /> Ref ®ere .,." <br /> Gas Fireplace �• her Floor Drain <br /> .. <br /> Weed Stove Kitchen i D ' � <br /> GasRangeI3ftcilra#. tspcas Graeae <br /> Olet ttzku4s her E <br /> a► at Roof Drains <br /> _.. _•_-Heed �Cletha�s -aslier ..Icat.Ga� <br /> e,v.st Fanum" dater ffeater Other. <br /> r <br /> sio I cemeriMel etc,) Other, <br /> SP lINKLBRA4triP; <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.'/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.I am the owner,or I am authorized by the owner of this properly 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 /> 1 PE T i (-) zs sK <br /> t?w•ertAttthatc#xed.A�-, Signature (XJ <br /> Oats; . <br />