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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)425-257-8810 I FAX 425-257-8857 j(E)everettopageyeretteri4Okt l wwwa v3efettvwa,goWpei tTi ..... <br /> (fititili4rAtiliakialiellrily-'It as tEgitit <br /> i� ,� _x <br /> PRECTSITE ADDRESS: I"s .,- YV r<, <br /> ri PROPERTY TAX#: <br /> t4EAL for new construction: Short Plat/subdivision <br /> Ler No. (attach copy of long legal description) <br /> CCONYA r�,-'1 MAT1aIira re e '...../'''&4 <br /> 1, <br /> OWNER NAME. ifil.4 r0� <br /> OWNER MAILING ADDRESS: STREET TENANT NAME(If CommerOiei): <br /> I <br /> CITY; y .r• 'j A <br /> OWNER PHONE: STATE VV zle 0 Z0 <br /> ",.." .�.._ . OWNER EMAIL:. <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET I Li. <br /> CITY ar, ' iY STATE A '117^ ZIP, v <br /> CONTRACTOR:PHONE: � 0 s� <br /> CONTRA mAtt 4is <br /> ` ";ti' ' '.0446144'44P s , ; <br /> PRIMARY CONTACT: 0 OWNER a' CONTRACTOR 0 OTHER(Please Specify) j <br /> CONTACT NAME: CONTACT PHONE: 5 25 '� <br /> "De-Jato <br /> CONTACT EMAIL ' <br /> A„ i'D t <br /> ati.< Use , y <br /> of Oulldirl*: s,,'. . lfii R �, <br /> rig �'� � �.,.,. � �s '. <br /> Contract Price of Work:$: ie C) <br /> P1 ®; Use of Buiidit*; <br /> uPfdl . P. . . Source: OGas EI�d. DOther <br /> pe: Fft Iached OSFR Attached OD _.; <br /> T 46 of Pro act, ®Mew ❑Addition Pelf ❑Multi Fa Ev 4of Units, ❑Commercial Olndusfrlal <br /> LJRtstn tel D'', 0 air. OT.I. D$ra <br /> DESCRIPTION OF WORK: O aflrr t CI Demolition DOtiar�e of Use <br /> f <br /> ASSOCIATED BUILDING PERMITa# if s*livable: .. <br /> MECHAN1cALSPERMIT I ic4 Y$} I' 4'T t"" 49 -', <br /> Type of Protect: , New,,,� Addn �.• M �� ).< �'IC'1i3F� �:. <br /> #of __Alteration _Repair Type of Project: New _Addn <br /> , orf, le :.tttRAAloT s !OF, ,ti .,.#°f <br /> wAtferation '_Repair <br /> - o - <br /> „ lr of <br /> AIC-Air '" —�"`"""- f: ef-�xftrres <br /> I Heat Pump Tenet <br /> Forced Air ,e Unit HeaterUenItf s�rY:R re ttterr ittsif <br /> Gas.P"•zt� »stft - U ct'a <br /> l <br /> WaterHeater '_ eoi <br /> �h:--ala; Frtortr Dr`Fountain <br /> Gas Eire�iia . � �. �.` <br /> Wood ttwe' 1 Greti Drain <br /> Cas .� Otietie� �IClt�ett=Sint( '•....�-� . GreaeeTr-e <br /> ClothessRa Dryer i is fcups Other: sft s tier ,Roof Tanis <br /> Ca h ert cleft**washer Medleal Gas <br /> ttst Fan Wer eater cher <br /> eft SvIE3aillto., <br /> Other) <br /> 'SC i�tEi1 UPPRESIO S tEs. ' � <br /> .: <br /> Chemical or Water <br /> No.of Heads <br /> ACKNOWLEDGEMENT 1 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 W <br /> Building Official before being authorized under any circumstance.1 am the owner,ort 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 /> '` PERM T <br /> Ow,arJAU1horteadA a SI nature '" f : <br /> `° Date ` <br /> ' - � �(ix.0 sd ° = ,vis 61+" <br />