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PERMIT APPLICATION <br /> BUILDING /MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> 0.7y...A <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> {P)425-257-8810 I FAX 425-257-8857 I my everattees averettvoa4ovi www.everettwa.gov/permits <br /> itit ii .l l i.��4 ni y Pl 4 '1--''''-'s",'-'llittiiii cTrs1 E$ 4`" t 7 "k <br /> PROJECT SITE ADDRESS <br /> yj°":' � 3l 'ERTY TAX#. <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No.= (attach copy of long legal descriptfon) <br /> "C TA e. s 41 1 g" x +a 1I §:!"'•,.. -'' <br /> OWNER NAME. <br /> #o g`ego ,0 a 4, TENANT NAME If CerrtnwerO <br /> OWNER MAILING ADDRESS: srnaar <br /> CITY <br /> o .. . i"'d� ".n4$ STATE A Li0 .., <br /> OWNER PHONE: ` <br /> ... OWNER <br /> �.. �' (p EMAIL:::, <br /> ' ' <br /> CONTRACTOR NAME, s" <br /> CONTRACTOR ADDRESS;. sTRssT "1 '" <br /> CITY, STATE :. <br /> , , LIP fcmie. .'!2:0 1 <br /> irlieti) e.„ <br /> CONTRACTOR PHONE t5 CONTRACTOR EMAIL <br /> -- - :h �. <br /> PRIMARY CONTACT: ❑OWNER s t ONTE A 't'0;R 0 OTHER(Please Specify) . <br /> CONTACT NAME: CONTACT PHONE <br /> �j(J, X2.5 25q` 05 <br /> CONTACT EMAIL t�. <br /> Ertr t ed Use <br /> Usf^ifl I A ContractPfice of Work: <br /> , a 0 " <br /> of Blind' m <br /> Heat Source: DGas '-`At'" trIc ❑Other <br /> Btafldi ? - �h : ❑SFR-Attached <br /> TA.",a of Pro 0«,,,❑New ❑Addition °Remodel ❑R I irst, �t,n lOStI f1 hof Units:ter ❑Demolition o ❑Chen of Industrial <br /> DESCRIPTION'OF WORK: .Sit CITA. C7Sd®n .,, Use, <br /> ‘VI S-t a-(k d ve,t-1-esS 1p ,,c.,r),, <br /> f) <br /> ASSOCIATED BUILDING PERMIT# Ifes"nlicable) <br /> ISTI `ALIPAHNItT-44 :;14'100 r 4471 1 :r ,. j t4! Ei411 <br /> ..r <br /> Iwo:of Protect _New Addn Alteration Repair <br /> if* Type of Project ,New __4ddn _Alteration _Repair <br /> .m x<, . " " a :f#1xt & ." #of Litt ffi hof <br /> AIC—Air f Iatli tlfll+ Units fxftrxa ? isrtrllras <br /> Heat Plan. _ T�*t <br /> F/" tires' <br /> Forced Air Systems Unit;Heater l rtftei Preventer ns« f d w <br /> •: Gas�Rl�ln . -atttftift. <br /> tier Ute € <br /> Water Heater [ att "1 _ i n <br /> Ref aerattc Shower � r Fountain <br /> ;: �Ffra e� Floor Drain- <br /> ' <br /> Gas R �a_ Stove Kit k&t)1 =mat <br /> 'tar.e OucUn .01$hwe <br /> othe 0 er-Hookups Other <br /> 4f Ti-'' , <br /> Ft+edicof rain <br /> s>�te#tias a�".�_ <br /> Hood Medical baa <br /> Rea- et oo '•'t'Heater other <br /> 1 Sink(Servideiflarilkflopietc,.` Other <br /> ti t <br /> 1 t rt ' LftiPRESSt `f `I STtt`4.>qf i <br /> ``N <br /> Chemical or Water ". .: <br /> 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 /> 8uldfng Official before being authorized under any circumstance,i am the owner,or!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 J1CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> '`r ► <br /> PE •R <br /> ow erfAuthbrtzed_Au, t l " ft ..... 411 -• 0 <br /> iy <br /> Ii tature , <br /> Date <br />