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• <br />C� <br />PERMIT APPL.ICA,T�Q�V <br />BUILQ#N�/MECHAN�CAL/PLUIII�BiNG/SIGN/SPR�NKLER/D�M�LITION <br />CITY OF EVER�7T PERMIT SERVIC�S <br />3200 Cedar St., �verett, WA 98201 425�257-8810 FAX 425-257-8857 www.everettwa.org <br />OPERTY TAX # <br />LEGAL for new construction� Short Pladsuadivision Lot No. (attech copy of long legal descripti�n) <br />OWNER \ i 1�+ �S� <br />Phorte/E-mail <br />CitylStatelZip <br />/ <br />� �wnef _ �Wfl@T's Agont � CofltfACtot _,,,_ Contfactor's Agent _ T9nant (muat vrcvicA R I�n�,r of con:ent rrom Ihe awm�rto do wortc in Ine evp�R) <br />ONTRqCTOR <br />drass <br />BUILDIN� PERMIT APPL�CATI <br />StatE Lic. ���'�1� \Z.`� C, Ci Bu3. LIC. �f � <br />Phone�Email a���� O�. ` <br />CONTACT FOR PERlNIT <br />�C�`C'C� � C�� �O.C'S�re (`o�� n� c.a'Y1 <br />phanelE-m�il <br />CONTRACT PRICE OF 1NORK l.o_, ��S` � <br />Existing Use of Building _ .— _ _ <br />Proposed Use of Bullding G99 <br />Building type: _,,., Single Family , Duplex �Townhouse _ Mutti-Family T Commetci€�I <br />Tvpe of project: New Addition Remodel RepRir =T,1., _ Slgn. Sprinkler De <br />D�SCRlf'TION OF 111/ORK (sdd/tlonal spece provrued on tna becic) ; <br />(a..�.Q� 0.0 e C.ex�Q �' `�'� �� r-� R2e.�c -� 1,'�'Stj . <br />�1f��C�#A�IIGAL PERMIT APP�,ICATION <br />oF ProJoct: ,_New_Atltln ^Alteration _Repair <br />ShowNumber # vfflxtures <br />A/C – akr handlinq units <br />Forced air SYstems <br />Water h�ater <br />Gas �ire lace <br />Gas ran e <br />Clothes d or <br />Ran e hood <br />Exhaustfan <br />Heat um <br />Unit he�ter <br />Boiler <br />Refri era#ion <br />Woodstove <br />Ductin <br />Othor <br />NKLEIR / SU�PRE <br />Number of WE <br />on� sxsren� <br />souRCE: <br />Elect <br />PERMIT APPLICAT�a�I <br />oF ProJcct: �New _Adtln _Alteratlon �Rspair <br />Show Nuri1BP� (!S) of �xtul'85 <br />I Toilet � � <br />oisnw�sher <br />Clathes washor <br />Urfnal <br />Drinking Fountain <br />Floor draln <br />nneaicaf Gas <br />Other; <br />Other: <br />I herab,y certlfy thet I heve read end ox�minetl thla spp�IcaUon nntl know mm s�mn }n hr. trua nntl eortnct, �II provl�}on� �f Inws nnd ordinnnena govr.ming this rype of work wltl be aompl <br />witb whelher �peclfletl hercln or noL 7ne prAn�ing oF a permit doee not preeurne ta pive euthorlry to vlolata or cencel the provlslon of any other atete or local law repulatfng con�trt.icllon <br />TRat 1 om a Ihorizntl Cy tho ownor of t�ls proD�?rty to perform lhe work for whlch appllcatlon fa matle and I compiy wilh tlie Stele Contraclors Law 18.27 1�CW a�ntl 296.ZOOA WA0. <br />• � � <br />owne,r/Authoriz Agent 9lgnsture D e (Rmvlsed 4/7.015) <br />