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PERMIT APPLICATION
<br /> BUILDING ( MECHANICAL/PLUMBING 1 SIGN f SPRINKLER f DEMOLITION
<br /> — it CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT WA 98201
<br /> (P)425-257-8310 1 FAX 425-25T-8357 ((E)averetteosaeverettete.gev C www.everettwa,gov/permits
<br /> (Blue or BXa k tgl=tWiiiir P1448-04 i8 ) :_:SITE ADDRESS0 ' P*Ct T"tt' ' `td.+f u. ;0 '.
<br /> PROJECT' : �� � -
<br /> PROPERTY TAX#:
<br /> f-EGAL.faiF new construction: Shot Plat/subdivision
<br /> ..- " --- •- ...--,_. No (attach copy of long legal description)
<br /> OWNER NAME: Aikt.yw
<br /> TENANT NAME Of Cogatrn misty;
<br /> OWNER MAILING ADDRES ° sTRE--_ 14
<br /> OWNER PHONE; v. 'Read �
<br /> srxr $ zr. ilk
<br /> kiago� OWNER EMAIL:
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: sra ECT l 4. •""""
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<br /> CONTRACTOR PHONE: q STATE A ZIP A!
<br /> 0 CONTRACTOR EMAIL ,r . 4 .rt o
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<br /> PRIMARY CONTACT: Nii Bj- > � ." Jilt '" ,. 3R , ,- e. •a - s'r w "'
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<br /> RACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> CONTACT PHONE: a
<br /> CONTACT EMAIL:
<br /> Use ofBufildf !:: .:
<br /> Contract Price of Work:$
<br /> .Dd.Use of Istttrtir :
<br /> ttitt#is T se� Heat Source . "s ❑Electric ❑Other
<br /> ©3c=R-E7arte tISa' ttache ❑D[tolex
<br /> T a of p t:_❑New -rif' • units C7Ccrrsmereial
<br /> C7Adiition ClRemaifel ❑Re!air D ._. I Industrial
<br /> d.SCRIPTION OF WORK: E]T,t,• ❑ teat J aarg0 i t C1l7ema!ltion
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<br /> ASSOCIATED BUILDING PERMIT t�"; ' 1 0 CAS •�����``e.
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<br /> ;Type of Project ,New Addn Alteration Rep air Type of Project: NnwiAddn Alteration R,
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<br /> epair, __or ' #of #.ozri _ . � of-Fixtris7 kr tures allures AC-Air ttc1. .trdt iNeatiPtrT )et � r li at
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<br /> 11.101
<br /> ilinlin MINN aid!)Forced Air t8tem Unit Heater Sat tUtt, Ur nGia c3 t ash sift Fountaint Rrean n- Shower Drain tr e d Gtcue: ittatiutnc. DJs.af Grease TrGas Rai.. uottn. allall s 'Roof-Grains
<br /> Cdsih * Hookups- tether, trothes.Washar Medical Gas Water l tar Other: ..ktFan �IlSink ,eruicet8ary g etc., Ctaer;
<br /> NM NMI
<br /> 1111111Mirisaii MN"
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<br /> Chemical or Water
<br /> Nc.cf Heads IIMI
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<br /> tir011titag cI a Ferman cat ata cwcrkr n rata Ls datio a and cored, elt.WO*dace wwrseJanf to`rn/ pandit
<br /> O rr if. d s taxis fag gall'ttstr arrant arc,. ' Gr3iEs aF vr3sf wcrk and no dews{iwrs lherefrr rn t viatt a must.first l e. t odzads wd can!),.y li
<br /> and dcan,O},„arth"t1- aheState,v;,rity circumstan a.l am this owner,
<br /> er„Law 16.27 fTcw onq 25G.2sj WAC, `°J ram eut�ed t: the csvrst of lhfy:RrcFdrt 1p,p rt a»tduc rorlr"tzs tar tcF g tram r1;s
<br /> �t+kkratFsr.is�:are*;
<br /> City of Everell Official Use Only
<br /> ...: ..411 G PERMIT�#h
<br /> OW'44hAutlitartted"Axsa toe . It
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<br /> Date � � ��
<br /> ,. ,.a, ad"9aizot61:
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