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�ERMIT APPLICATI rr <br />BUILDING/MECFiANICAL/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 />RESS: <br />� Z �� ����� <br />EGAL for new construction: Short PlaUsubdivis <br />�tJ <br />OWNER �K � lU �r I� "V� ..� --S' <br />Address ��'U C' ��4-r� �2�, �t �jOv� ` <br />APPLICANT: _ Owner _ Owner's Agent �C Contractor <br />CONTRACTOR �'{� � �%- � f-�-{ /L, <br />Address �/ � I z C�� �t/� �% � <br />T� ����� <br />�� � /� �, ��� � � f <br />BUILDING PERMIT APPLICATION <br />TAX q <br />PERMIT # <br />� Lot No. (attach copy of Ibng legal description) <br />Phone/E-mail �z '—' � / 3 — �1^�i 3 <br />: �6� City/State/Zip / h rl �- Ul � f /%// rl ✓1 �S�%� �' <br />Contractor�S Ageflt _ TeflBflt (must provide a letter of consent from the owner to qp work in Ihe space) <br />State Lic. #/i� L%1LD/� � R �� City Bus. Lic. � <br />�,LKIj1..,_,n 't/�' 9� Phone/Email y� �- � S'.€j � �L��� <br />CONTACT R PER IT <br />��� ��o�o� <br />Phone/E-mail �.?J�' ��6 ' �%� CJ � <br />CONTRACT PRICE OF WORK Z�, d-�� <br />Existing Use of Building � <br />Proposed Use of Building ��"� <br />Building type: ,_ Single Family _ Duplex _Townhouse _ Multi-Family ,� Commercial <br />Type of project: New _ Addition _ Remodel _ Repair � T.I. _ Sign _Sprinkle <br />DESCRIP�ION OF ORK (additional space provid�on the back) : <br />�z���'J �Lt.�rn� ]� - �1 � <br />/� <br />P <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixfures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes drver <br />st fan <br />Unit heater <br />Boiler <br />Refriqeration <br />� utner <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />_ Electric_ Other <br />olition Change of Use <br />MIT APPLICATIO <br />Type of Project: _New _Addn _,Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />Dlshwasher <br />Clothes washer <br />Water heater <br />Sink (service/ba <br />Backflow prever <br />Urinal <br />�rease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />n <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 />wiih whet er specifiBd herein or not. The granting of a permit does not presume �o give authority to violate or cancel the provision of any other state or local law regulating construcfion <br />Tha � a $uthorize by the wner of this property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br />�— <br />`.�- � z9 � S <br />r/Auth riz Agent Signature ate (Revised 4/2015) <br />