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• ������ ����Q����� <br />��1��IN�/���C���D���.I���9��1R��/�I�l�/���9���,��I��V���A`�w�ft� <br />'� CIl'Y OF EVEREI'T P�Rilfflll' SE}3VICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />'AX # <br />PERMIT # <br />..,,. `2 � c� � � 1.ti � l�-;�- �. ' � �r�r���7 ��i �i'4' �. �� �—�j�.%� _ _ _ <br />for new construction, Shorl PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER V�i'`�L-���1.� <br />PhonelE-mail !—��'Z�j - Zj�C� •� <br />S�-1 1 f .�i.b'�-�-i�� (' -- �City/State/ZiP I� ' V�:—�;"�,�,t-.,: `�� ��' "l.—�-� r n <br />CANT: _ Owner _ Owner's Agent _, Contractor _ Contracior's Agent _ Tenant (must provida a lener of consBnf from me owner fo dp woric In me spa�e) <br />CONTRACTOR � �� i'� �.-� <br />Address '� ( � � � � C lL� <br />�v� � <br />State L'Ic. # <br />Phone/Email <br />City Bus. Lic. # <br />CONTACT FqR PERMIT � ��� �, � <br />� z--� - �r �- <br />Phone/E-mai] (�� (���-.`"7�-}�c�lf'"_�G��� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WDRK <br />Existing Use of Bullding �Q�� ����-- ��"r�� <br />Proposed Use of Building �� <br />Building type; ,� Single Family _ Duplex Townhouse _ Multi-Family � Commercial <br />Type of project: _ New _Addition _ Remodel ,_ Repair,_T.I. _ 5ign Sprinkler_C <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />HEAT SOURCE: � <br />Electric Other�,� �i�Z-� <br />olition iCChan9e of Use _ <br />��'w� �"� �. �'�L�-Gj � 121;� �► �-�-'�ciZ � t" �� � r`.._ 171 � � <br />�� ��p ���Eu� r�( V �� �, i t2��2'� -1 z ►�. �S � �� � vv s� � � � � <br />of Project: _New _Addn _Alteration _Repair <br />5how Numker (#) offixfures <br />A/C — air handling units <br />Gas <br />nit heater <br />odstove <br />SPRIRI�CLER J Sl1Pi'RESS901d �X�Y�M <br />Number of Heads <br />ofProject: _,New_Addn ,_,Alteration._Repair <br />Show Num6er (#) of fxtures <br />Kitchen sink & disposal <br />Dishwasher ' <br />Clbthes washer <br />Water heater <br />Sink (service/badmop/et <br />Backflow preventer (insi� <br />llrinal � - <br />Drinking Fountairt <br />Flaor drain � <br />Grease trap � <br />Roqf drains � � <br />Medical Gas <br />Other: <br />Other: <br />I hereby cerfify ihat I have read and examined this appllcatfon and know ihe same to be true and correct All provisions of laws and ordinances governing this iype of work will be complied <br />witll whether specified herein o� not, The granting of a permit does noi presume to give authority io violate or cancel ihe provision of any other state or local laW regulating construclion <br />That I am authorized by the owner of this prope to pertorm the work for which application is made and I comply with the Siate Contractors Law 18.27 RCW and 296.200A WAC. <br />� ����� � �l�o��`� �' 1� <br />Owner/Authorized Agent Signat e� Date (Rev(sed 4/2�15) <br />� �� <br />