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<br /> PERMIT APPLICATION
<br /> BUILDING / MECHANICAL/PLUMBING I SIGN/SPRINKLER/DEMOLITIONCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> P)425-257-8810 / FAX 425-257-8857 I(E)evae p everettwa.gov( www.everettwa
<br /> # fit Pleases „,
<br /> J _ ct;. _:'. .- Its
<br /> PROJECT SITE ADDRESS; �` "�
<br /> ,:4 1!.
<br /> LEGAL for new-onw± _ ..4 ..�,., PROPERTY TAX#:
<br /> c x ctickion Short Plat/subdcvialc;
<br /> Let No.. _ (attach copy of long legal description)
<br /> GM "Ar:It' ,ORA11Oi „,
<br /> OWNER NAME:
<br /> .42-t+ 1.
<br /> TENANT NAME(If Commercial);
<br /> OWNER MAILING ADDRESSµ STREET
<br /> _ A �
<br /> CITYA , � ��p�
<br /> �-
<br /> OWNER PHONE: srarF C✓t,/r'� 44a.
<br /> • YIP NP.,+�mw.
<br /> 4,„ ,, �.� OWNER EMAIL:
<br /> CONTRACTOR NAME ';
<br /> CONTRACTOR ADDRESS: t
<br /> CITY e, °:: _ ...
<br /> CONTRACTOR PHONE sraTE � ztR � ,,cer �
<br /> q Q` CONTRACTOR EMAIL
<br /> ge)
<br /> PRIMARY CONTACT: !OG) �C © 1 le _. t � _ 10
<br /> r
<br /> ❑OWNER A
<br /> OTHER(Please Specify)
<br /> L,,t;itt'1"ACT NAME:
<br /> "1)04-to CONTACT PHONE ,
<br /> Z5 25
<br /> CONTACT EMAIL
<br /> MWa1ta1;
<br /> Etre�� UseofIt�I : f_ ;.£
<br /> Contract Price of Work:
<br /> P��-. Use of fault �. � � ,
<br /> Build )yp ,� '' t Source ElGas fit, Other
<br /> I - laser' 00 ,feK DM „ F
<br /> ,I°e4f�'�,Je t- C3New "o �:' of units: OCommerclal ❑industrial
<br /> ❑Addition 0Remod i CIS a
<br /> DESCRIPTION OF WORK: tC ©T.is Cis f, ❑ Jttikter pDemolltion
<br /> hie?=, of Use
<br /> ASSOCIATED BUILDINGp
<br /> tMIT# a.plicab P
<br /> •;IVIfEdi-t�tdikl,
<br /> y afProJect _New mf ..:,. MWN = ,
<br /> .,A,,,, Addl.) „Alteration _RepanII R
<br /> #� Typo of Protect: New
<br /> _Addn Alteration _Repair
<br /> rrz -�rxttaree
<br /> #of #of
<br /> Forced NINNI� nIt$', si res
<br /> Heat Pump =J'illot.
<br /> Fixtures
<br /> ir S Oms 1rt-f-tooter rtO fT Preventer Inside t .NM A/0-Air
<br /> has'14106"'' � � ' Utl�
<br /> Water Heater liaiN goiter
<br /> Una f frf. rfan g ,NIX
<br /> as Ett�¢f ace I�rtnlSlA'I��tttvtaan
<br /> 111.1 r Greaseicat°terTt{l,
<br /> Oda Rate Stove Stilt..'�"; J,
<br /> C cafhes 0 OMs' RTr a,
<br /> Ma � - ' Other: ReefGGretna
<br /> Inn w.e Heed Cotes„ater ,Medical4Or: .G
<br /> s a s rt Water rater
<br /> ang Sink(ser lanlaINERMIllas MINNce/ arjt#"o, : i
<br /> rr�>S�h'F!1 �+�„�I'CJ�`'j a�1f' "t`Et °;..
<br /> analCttrslK �Et
<br /> i or Water
<br /> No.cf Heads liaillNanlniniin
<br /> ACKNOWLEDGEMENT.!have reviewed this application and confirm the information contained herein Is true and correct.Work done pursuant to.
<br /> current federal,stale,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first he authorized
<br /> Building Official before being authorized under any circumstance.)am the owner,er 1 am authorized by the owner of this props p this permit hmat comply with
<br /> end I comply with the Slate Cantrrctcrs Law 18.27 RCW and 296.206A WAC in writing from the
<br /> property to perform the work kr which application/s made,
<br /> City of Everett Official Use Only
<br /> �: 1 PERMIT#
<br /> ALS Opp i • (! a►. -
<br /> Aut6iffirtzesf- t 7[ec,pa�'�--- ---�
<br /> t itre' .� - �►
<br /> F..._
<br /> (I3autiSad- 24616)
<br />
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