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PERMIT APPLICATION <br /> BUILDING/MECHANICAL <br /> PLUMBING/SIGN I 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 I(E)everette .liveteitwa,giv 1 www.everettwa.gov/pertnits <br /> PROJECT SITE ADDRESS: € 'll, TAN--1:'`i __; a ; <br /> LEGAL for new construction; Short Plat/Subdivision "' PROPERTY TAX#: <br /> r_. <br /> Lot No,' <br /> •� (attach copy of long legal description) <br /> o�1ER NAME: ,��_ <br /> 41A, A 4,, 0 TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: srEErST <br /> � <br /> OWNER PHONE: ware za <br /> CITY , . <br /> 41 Al Zt) <br /> s,,. o rs OWNER EMAIL <br /> • <br /> CONTRACTOR NAME: <br /> a. <br /> g 11 tri C <br /> CONTRACTOR ADDRESS: srREET " <br /> 1/4 fir` o : <br /> STATE - .., ZIP <br /> CONTRACTOR PHONE: ` e° ": <br /> ••�t� � 0 � �� <br /> CONTRACTOR E(t/MAIL*0,,. , 4 , 'ar A <br /> 4 NRD-fa).: "1. a -4P"_ " <br /> PRIMARY CONTACT: °� tl ?t"=• • 4a° IfI3} iw <br /> Cif'— <br /> 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> De-JabLi <br /> CONTACT PHONE: .s 25l : <br /> CONTACT EMAIL: , a Alete 0 cCCD <br /> tiS�! Use of Rutin! tx . ... . ,� <br /> Contreet Price of Work:S. • •1I' •oa i Use of B€irdins: = <br /> Rulld'sr1 T aV r�"F Heat Source r47 es ❑Electric E7Other <br /> yp „� Detached ❑SFR-Attached E7Du"tax <br /> T .e of Prole ❑New P ��+tult�arrtlt 'f'to Units; ❑Commercial ❑Industrial <br /> j- L"]Addition C7Remodei °R3tair E7T.1, CISi_ Cly:riptfler CJDemolftion ElCnattxs of Use <br /> DESCRIPTION OP WORK: <br /> I ft 6k-c1.11 &A s i:- )9,.eIGc.� <br /> ASSOCIATED BUILDING PERMIT#if a°plicabie: 1 <br /> fVJ O ' i "+ L "lP '147„:411,0',;,,:`:;:,7,T,. w„ <br /> Type of Project _New a r y:. -i 14 : <br /> ,._„ Addn Alteration _Repafr l4 ION <br /> *°4F Type of Project whew gddn Alteration _Repair <br /> : t of <br /> a s . ixtrac-_ Fixture <br /> `�`a '-• Fix <br /> SIM xhtrsallIM AC-Air�ndige nitsHot pufToilet Baaktl Preventer Irr• <br /> eS a Forced Air SySl ms bathtublinnil - <br /> sas Pth• <br /> RIM or <br /> ifr : <br /> Washbasin <br /> . Founta1.11111 <br /> Mita <br /> MOM <br /> in <br /> Water Heater Ref 0eraton Shower FI -Drat <br /> Fireplace too Stove Klichen sink,A Dts .sal grrt <br /> MOM <br /> pectin Dishwasher RMedieaae�aliaa.iatfae . ,r Rooku®s then Clothes asher " C Minfan.- oWater ie t r Otheropst FanitSnkSe eiaer/ p./et j <br /> ism <br /> MIIMIIIINMIIII <br /> FfititiKLEaz"r�.i7.: t' pit ssi- Nz SYS1 E114 g t.?.NM , <br /> Chemical or WaterMill <br /> No of Heads <br /> 7tCAtt�4Vt3t"sE[�ifiT t have reviewed this sNM <br /> erin'o tsr7 D sl+rte,at.thav It#w. Me dram ep tet anal ion elle. <br /> oof et/Mettle;s a ekm the rrattotyeontained11�atern lrxee+tlee/red,Workp <br /> oIIIIIIIMIIIIIIIIIIIIIIIIIII <br /> uttva dtTl let betels- d1oceutl5 e• Mea lereleg i pp�wed wai t endeo a m'u enr le NV emtlt'mkt t4 do''''% <br /> K c urnstence,J am the ownerC ,.fir t srn ett vtthecris;ttterot ll''Devi Ilene bs sult:nrfid fra <br /> emit eomPlYw h the Stele Cor;treotors Law 18.2 " . d'' tie.ourer, lkts' tlkag 'n 1t a <br /> fat ar�c+?t2trp Ci € Yte pttp the work <br /> torwahiet attl r isrrsel <br /> Cif of Everett Official Use'060, <br /> Ir PERMIT • <br /> !W eflAutltorizad AgSignature $ O• <br /> -.eats' <br /> (Revised?13/2016j, <br />