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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P3 425-257-8810 I FAX 425-257-8857 eve <br /> Imo_ elfsreiogpu l www.everettwa gc»fpalis <br /> PROJECT SITE ADDRESS: <br /> PROPERTY TAX#: <br /> LEGAL.for new construction: Short PIat/subdivisipn <br /> No. (attach <br /> 6 copy of long legal descnptlon) <br /> AlwlMw,_r L �Y A':M <br /> r r O TA til It 1 ION 4 ° , T' 1 <br /> OWNER NAME: <br /> r •fig TENANT NAME <br /> (If Commercial): <br /> OWNER MAILING ADDRESS: STREET ' tF•• ° , <br /> i .- IVB ' <br /> CITY <br /> .._.. .STATE _;,....,�' rt� r� <br /> ... ZIP ,., <br /> OWNER PHONE: ,,�0 ,+ <br /> CONTRACTOR NAME: -: . ffi <br /> n ark''9t h C <br /> CONTRACTOR ADDRESS: STREET i eF P ` <br /> CITY ,°' .F. _ STATE ' : ZIP'it•,s � <br /> CONTRACTOR PHONE: "' t <br /> .o t ITFACTOR EMAIL ,3, AlA" " r gfie .00 <br /> PRIMARY CONTACT: ❑OWNER <br /> ��GQNTFiAG'tOR 0 OTHER(Please S•ecif ) <br /> CONTACT NAME: c CONTACT PHONE: <br /> V� la io s" 255 • <br /> �,, CONTACT EMAIL. , <br /> v <br /> Eeisdng';Use of Build . . <br /> Contract Price of Work:$ -..;,; <br /> .11 <br /> Proposed Use of Building: Heat Source: ❑Gas >a <br /> edit ❑Other <br /> Buildtttg Type p(sFR,DeNtohed ❑SFR-Attached CiOOuptek CIMUilt«Family4tofSnits: ❑Commercial Olndustrial <br /> T4.e of•Prajacf: ONew DAddltion DRemodel CiV �=,•Ile {7T.I. Ostia IDS. 'rimer I:Demolition D ;':. >a of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#,ifazi.'icable <br /> Mg` 10, 0 i A r.q•t° ic` =io1Y a�4 ' 15,71.-:;1.';'`,A...):',',1 '''''-:,'Aa'" t <br /> Type of Project. _New Addn Alteration _Repair Type of Project New `Addn _Alteration _Repair <br /> #tri` #of <br /> I� t,Tfture�r ""`� £f�f itllXf ICie tll rt <br /> frrgg <br /> IINNIEA/C.—AirHandiie! lint a WWI Heatlurr. Miling Toilet <br /> ForcedAirs',tetTT: lalmn. Ba iew rt t'tlttt' .nsitls BI,t`. <br /> Milli MEM Gas PtpP 171"�i■I■�� a atlon Laghtttlr Urinal <br /> r <br /> milisz <br /> P BollesionReittr <br /> s�i3t�fs A Wash Basin � ' <br /> irtnkja Fountain <br /> Shower <br /> FIor Iraln`. <br /> Wood IOVe 11111111Xiteherl "Pk-401st t-mum 0 111.11111EtnINEMNIIMmanig Re",.t,‘ Ducting <br /> Clothes t er Fiatilct ps=III <br /> n Dishwasher $ I3r�rlrts <br /> Pantie Hood It ttie Witte Medical Gas <br /> aa€�a shFan MIWelty EMIOther.: <br /> Singlin <br /> t .ervicearil0.;,aa Other; <br /> h '4= Il�NK l tSUPP mom SYimis <br /> i T I. ,` <br /> illChemical or Water No.of Heads " <br /> °ACKNOWLEDGEMENT.:t 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 end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Stale Contractors Law 18.27 RCW and 296.200A WA C. <br /> City of Everett Official Use Only <br /> r► PE' ,t' • <br /> Ow,er/Autitorized;Age '•Stgriatur <br /> . Batt# *, <br /> tFtrl :, ac" at+ .. <br />