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�ERnni-rAPPL�cA-ri� <br />BIJILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />1''� I,(.' f� L� r� _�;� � <br />SITE ADDRES •, � C� ` �' �Jg, �„ ,,�.. <br />�-� r����, <br />LEGAL for new construction: Short PlaUsubdivision (�(1,1I� <br />OWNER ��Ncsn-P\'v �r�,v�' `�' G�\�� `VU�1�� . <br />Iress <br />���� �. `'�j�v l�l,'�. <br />PLICANT: _ Owner _ Owner's Agent �Contractor <br />NTRACTOR C.� �V L�' <br />Iress /� l V� r'�l�• SV--�' �bl� <br />BUILDING PERMIT APPLICATION <br />TAX q � �- P RMI # <br />�� ��3 `G�-� <br />No. (attach copy of Ibng legal description) � �(Z <br />PhonelE-mail <br />ICity/StatelZip ���� �,�,�/`� <br />CofltfaCto��S Age(lt _ Tefla�t (must provida a letter of conseN from the owner to dp work In the space) <br />State Lic. # . City Bus, Lic. # � � �j � =� � � <br />� �� � Phone/Email �� Z�j �j L,�„1 . <br />CONTACT FOR PERMIT �- <br />A��/�G'-�� �c'ly1('a S; , „�-� i <br />Phone/E-mail ��p� L `��� �. "3�� cl <br />CONTRACT PRICE OF WORK �d �< <��l <br />Existing Use of Building � � � �5 �� <br />Proposed Use of Building S' • �� <br />Building type; ,� Single Family _ Duplex _Townhouse _ Multi-Family ,_ Commercial <br />Type of project: New � Addition Remodel _ Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back): <br />� <br />� � �S ' �� � � iC.�t � � � �b K(Z-I <br />P <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling 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 />Unit heater <br />Boiler <br />n <br />� vtner <br />INKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />_ Electric Other <br />olition Chanae of Use <br />CAT <br />Type of Project: _,New_,Addn _Alteration,_Repair <br />Show Number (#) of fixfures <br />I Toilet <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer (ins <br />nking Fountain <br />or drain <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether sry�cified herein or not. The granting of a permit does not presume to give authorily to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner of this property to perf the work for which application is made and I comply with ihe State Contractors Law 18.27 RCW and 296200A WAC. <br />�---� ,,. "'/. ' . .--------� � ! <br />r' � <br />,� �--�"=-==_ _.; - 1;"Ic c -�; <br />; . <br />Ow " fAutho ized gen Signa ure � Date (Revised 4/2015) <br />`� <br />