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����������.����a� <br />��������,����������,�������������,���e���������������� <br />� CITY OF EVERETT P�RI'�Il' SERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ITE <br />OWNE <br />CO <br />PROPERTYTAX # <br /># <br />�,... � O l l 0 0�0 3 � 1�7 �!-JU� <br />3��E�2G�1l� Op2 ��/�E�T' IM� �03�t'� t3 <br />for new construction: Short PlaUsubdivision Lot No. (attach copy of ibng legal description) <br />R ��'.� v� 1 � o�- �'i� �O�N D Phone/E-mail � ( ��''•G�Q "� ���D \ � � <br />r'�.�j '�C�� %�. �a/��"TT"W�% ICity/State/Zip <br />VT:� Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant (must provida a leuer of �onseni from �he owner to ap work In �he spa�e� <br />Lic. # <br />Phone/Email <br />BUILDING PERMIT APPLICATION cONTRACT PRICE OF WORK <br />Existing Use of Building s��G� ��� (� 1 <br />Proposed Use of Building ��_�� �Z L��� G` <br />Building type: � Single Family _ Duplex _.Townhouse _ Multi-Family � Commercial <br />Type of project' New Addition Remodel X Repair T.I. Sign _Sprinkier _C <br />DESC IPTION OF WORK (additional s ace provided or{ the back): <br />S,n.C'�c� l � 3� 1� ��- C'-o�k �. n-�e� W� l�7�0' ue�'*f �� f G.i ��i � <br />�rYto�. � � g�a(o bcrt �..)� C�ew � o n I an.n , s c'c�,� r��` rr�►� on s� . <br />R,�� o.� e p n d l� c G 6. o o� w� 3 u x 3�d�.00r <br />,•1nr-4a�� 12xt� ECo ��e�� ne -- -------._ _. <br />of Project: _New _Addn _Alteration _Repair �YF <br />Show Number (#) of fixtures <br />A/C — air handiing units <br />Forced air systems <br />Gas piping <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 />� Ductin <br />� Other �'r'' C � C "'� <br />SPRIY�KL.ER / SUPf'RESS! YS EM C <br />Number of Heads ' <br />City Bus, Lic. # <br />Ze� 00 <br />HEAT SOURCE; <br />/ Electric Other <br />� . . <br />olition Chanqe of Use <br />of Project: _,New _Addn �,Alteration _Repair <br />Show Number (#) of �xfures <br />i Toilet <br />Kitchen sink & disp <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other; <br />Other: <br />I hereby r�ify ihat I h�e read and examined this application and know ihe same io be irue and correct. All provisions of laws and ordinances governing this iype of work will be complied <br />wilh wh her specified e" or not. The granting of a permit does not presume to give authority to violate or cancel the proVision of any other siate or local law regulating consiruction <br />That I am au o er of this property to pertorm the work forwhich application is made and I comply with the State Contractors Law 18.27 RCW and 296.20�A WAC. <br />� ��� � <br />� e�� i� <br />� ���� <br />Owner/Autho ized Agent 5ign e Da e (Revised 4/2015) <br />�1z <br />