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CO <br />������ ���������� <br />��I����������������������I����I������0���������������� <br />� CITY OF EVERETT P�R�VI11' SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />� IPROPERTYTAX# <br />--.--a5i� (�a,Krr �v� �-�c-� `� I����'S ��00`10� � �+��vo- <br />for new construction: Short Plat/subdivision Lot No, (attach copy of Ibng legal description) <br />Jc'_�'P;n�v 1^ <br />Phone/E-mail 4� C�� _� �'� �� S���ecc�y�c)cfc��L <br />Owner _ Owner's Agent _ Contractor _ Contractor�s Age�t _ Tef12f)t (must provida a leller of consent f�am the owner to dp work In the space) <br />la�cc Ll-L �State Lic, # <br />�,.11� � � I e� � <br />� <br />Phone/Email <br />� j'�5 City Bus. Lic. # � <br />�-�7� ��56� <br />TENANT BU51Nt55 NAmt ���� �^� � � ^+^ ' J �'��,,�y � Lr,�.y �� <br />/ <br />�G��c'r-�� Phone/E-mail`��-53�'�7 cjece»� �je�^t� �N�sm��' ,ce�w <br />BUILDING PERMIT APPLICATION cONTRACT PRICE OF WOR S of� <br />Existing Use of Building �nmus �� � U p� � HEAT SOURCE: <br />Proposed Use of Building �� � up L�2D� �as_ Electric V Other <br />Building type; � Single Family V Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project New Addition � Remodel Repair T.I. Sign _Sprinkler_Demolition_Change of Use <br />DESCRIPTION OF WORK (addifional space provided on the back): <br />_ , , J-�,�r��i �"-�('GC...- <br />u.�;1" �';� % `"� <br />s��ar�--�o,.,-� ��c� .,C (('c� t��; »� � r'S �'1 �,�e� <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) offixtures <br />A/C - air handling units <br />Gas pipi <br />Water h <br />Gas fire <br />Gas ran <br />Clothes <br />Range h <br />Exhaust <br />Heat pui <br />- � Ducting <br />� Other <br />SPRINi'CL.ER / SlJPP9zESS@OBd Sl(STEM <br />Number of Heads <br />Type of Project: _,New _Addn ____Alteration _Repair <br />Show Number (#) of �xfures <br />Kitchen sink & d <br />Dishwasher <br />Clothes washer <br />Water heater <br />Grease trap <br />Raof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby cerfify that I have read and examined this appllcation and know ihe same to be true and correct. All provisions of laws and ordinances governing this iype of work will be complied <br />wilh whether specified herein or not, The granting of a permit does not presume to give authority to violate or cancel ihe proVision of any other staie or local laW regulaiing consiruclion <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with ihe State Contractors Law 18.27 RCW and 296.20oA WAC. <br />�//l �� � �� \ (Revised 4/2D 15) <br />Owner/Authorized Agent Signature Date <br />1 � <br />