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� ���.�a����aa�a� � <br />��S�.�O��IG����/�f�a���l�l����l��/�1��/��'G�B�I��.�1����G��l�d`���I� <br />�� CITX UF EVERETl' P�}�Ml�' SERVICE� <br />3200 Cedar St., �verett, WA �8201 �25-257-$810 FAX 425-257-8857 www.everettwa.org <br />� S�TE�A� DRES � �1 C� ���-� <br />'t <br />L�GAL for new construction: Short Plat/subdivis <br />TAX #i <br />PERMIT # <br />�U�l ��lQ�' <br />No. (attach copy of long legal descrfptifln) <br />— . . ���� - z :�-I - 3��y :�; <br />� C '('�� I� L� Phone/E-mail �✓ <br />OWNE ,- � L� <br />I �-�n ' — � _ � Ci 15tate/Zi [ �'-^� �.-�'�2'(�'�, �, �� � � �;.�,� <br />� Addless � 1��� -�, �r.�� , �\ir iY P -�?� . <br />APPLIGANT: Owner _ Owner's Agent ____ Contractor _ Contractor's Age�t _ Tenant (musl provida a letler of consent froin the owner to dp worh In the spa�e) <br />BUI�DING PERMIT APPLI�ATIOM <br />Lic, # <br />Phone/Email <br />'ACT FQR PERMIT � �,�� <br />�E-mail <br />'RACT PRICE OF WORK <br />Bus. L.ic. # <br />Existing Use of Bullding �r��iilll%�� �t' f�YiL� HEAT SOURCE: <br />Froposed Use �f Building �������i �fli � L� � I�'��'� Gas_ Electr <br />Building type; � Single Family _ Dupiex _.Townhouse _ Multi-Family � Commercial <br />Type of project: _ New _Addition ___. Remodel _ Repait _ T.I. _ Sign _Sprinkler_Demolition <br />DESCRIPTION QF WORK (additional space provided on the back) : ' �(y.��. <br />� � j ( � `�'�.'� �� � i �� � - <br />��- �� �.t �� ��?�r!i�� � n 1 IE'�r�ct �� Yt .� rr�e���_c _ 4-� � --F.�.�c�� , <br />� °('�"'�.� _ � � d �� �l i ���-��t � ; �=<`� " !�n fI e � iv�,� s io � '� N� o w � ¢�r. <br />C. i= 1 c1 �� ���, a-�-- <br />of Proje�t: _New,_Addn _Alteration _Repair <br />5how Numker (#) offixtures <br />A/C — air handling unifs _ <br />Gas <br />eater <br />Woo <br />SPRIf�9L'�C��� / S��'PR1E��fl�Bd ��l�'��i�l <br />Number of Heads <br />ange of Use <br />c� �� ;��L�ir� t rl <br />of Project: _.,New_/#ddn ,^Alteration _.Repair <br />Show Number (#) of fxfures _ <br />Kitchen s�nK t� aisposai <br />Dishwasher ' <br />Clothes washep <br />Water heater <br />Sink (service/bar/mop/et <br />Backflow preventer {insi� <br />Urinal � - <br />Drinking Fountain <br />Floor drain � <br />Grease trap � <br />Roof drains � � <br />Medical Gas <br />Other; <br />Dther: <br />� hereby certify ihat I have read and examined ihis appllcation and know ihe same fo be irue and correct Alf provis(ons of laws and ordinances governing this type of work consiruct o��ied <br />�,yiih whether specified herein or not. 7he granting of a permit does not presume io give authority io violate or cancel ihe proVision of any other siaie or local law regulating <br />Th am auth� aed b ihe ow r of this ro e t erf e Wofklor h,i h a�p,l� at�liis made a�d 1 comply with ihe State Coniractors Law 18.27 RCW and Z96.2D�A WAC. <br />�lC �- L=�E�? i��'pt�`�� i�� J�I�C�� � f% r`' , <br />: ,, ,/-'l 5 t G�/`��� - <br />L L � 1 �`� ' � (Revised 4/2015) <br />Owp�r/Au horized A ent Signa ure Date <br />r������ v�rt�o�� (,������f�' ��1�� �?� `% . <br />� � .�'�C' ��:,SC�.��- <br />