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�ERMIT APPLICATIO� <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 982Q1 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ITE ADDRESS: <br />LEGAL for new construction: Short PlaUsubdivision <br />�— <br />OWNER J � � / � �„ <br />Address ��1 ��� �� f ,¢✓� �� <br />PLICANT: �Owner _ Owner's Agent <br />CONTRACTOR <br />Contractor <br />BUILDING PERMIT APPLICATION <br />PROPERTY TAX # PERMIT # <br />��� i�'� � 5 0 5—�J 3� <br />Lot No. (attach copy of Ibng legal description) <br />Phone/E-mail � Zy - - 3 2 ` <br />City/State/Zip ��,��� (,� � <br />COfltfaCfOf�S A9e�l _ T2flaflt (must provida a let�er of consent from the owner to do work in the space) <br />State Lic. # <br />Phone/Email <br />hone/E-mail <br />ONTRACT PRICE OF WORK <br />City Bus. Lic. # <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric Other <br />Building type: ,_ Single Family _ Duplex _Townhouse _ Multi-Family ,� Commercial <br />Type of project: New _ Addition Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_ <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� <br />L �I �� y �+'tCiJ ��'� �'l � / �' / I% V: :��/1�`'� �-� �L � ��<-- �� � ' � r �!4'<— � <br />� <br />c�� � �� /t t 2 c� '� ��� %� � ir���;� ,��rt.�, �« r-�f w/ <br />Type of Project: _New _Addn ��,CAlteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />, I Forced air systems <br />vvater neater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Boiler <br />Refrigeration <br />Woodstove <br />of Use <br />, <br />I�Ii O lh, �D ��' C. <br />/ V U f�'ic� ��^ �% e-"f <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />i Toilet <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer (inside bld <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />( Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />j Number of Heads Other: <br />I hereby certify that I have read and examined this application and know the same to be irue and correct. All provisions of laws and ordinances governing this type of work will be complied <br />wiih whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construcfion <br />That � am a rized by the owner of this property to perform the work for which appiication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />7� ;�'' 'L �'/ <br />O rlAuth ' ed Agent Signature Date (Revised 4/2015) <br />