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��7^� '�' �'i7`�' ��y`/� j ��,� <br />4_ f., � i�, - i�, -� <br />_s � � a- �< < <br />�����I�����������������1M������������������������������� <br />CITY OF EVEREI"T P�RMII' SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />� /� :�G���: _ ,`��� <br />ITE ADDRESS: • <br />�CoS SeaVi� W <br />PROPERTY TAX # <br />r# <br />L�GAL for new construction: 5hort PlaUsubdivision Lot No, (attach copy of ibng legal description) <br />OWNER SGtjTf d" � ���/ "t- b� Phone/E-mailTl�. a�� a�3a S�LL� ���"'""` <br />Add�ess SOQ� SeGI/V( G� W City/State/Zip ��/� �� "�d �� <br />APPLICANT: �c Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant (must provida a lener or oonseN from tne owner to dP work In �he spa�e) <br />CO <br />BUILDING PERMIT APPLICATION <br />Lic, # <br />Phone/Email <br />'ACT FqR PERMIT <br />�E-mail <br />'RACT PRICE OF WORK <br />Existing Use of Bullding �l UIN�— � <br />Proposed Use of Building h-6�� <br />Building type: � Single Family _ Quplex _Townhouse _ Multi-Family _ Commercial <br />Type of project� New D( Addition �. Remodel Repair T.l. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on fhe back): <br />�%i ✓lal I nSpe G-Iz.ov1 � .��c (0 i red �'VY� � � <br />of Project: _New _Addn _Alteration _Repair <br />5how Numher (#) of fixtures <br />A/C — air handling units <br />--f Forced air systems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />SPRINKL.ER / SUPI'�E�SIOId <br />Number of Heads <br />City Bus. L�ic. # <br />HEAT SOURCE: <br />olition Change of Use <br />Type of Project: ^New _Addn �,Alteration _Repair <br />Show Number (#) of �xtures _ <br />Shower <br />Kitchen sink & disposal <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backfloiv preventer (ins <br />G <br />Medical Gas <br />Other: <br />Other <br />in <br />I hereby certify that I have read and examined this appllcation and know ihe same 10 be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />wilh whether specified herein or not. The grantin9 of a permit does not presume to give authority io violate or cancel ihe provision of any other siate or local law regulaling construclion <br />That I am authorized by the ow r of this pro erty to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.20oA WAC. <br />?I�( �`2� 20 5- <br />." `�. . ___: �.___..._.. nate (Revised 4/2015) <br />