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���1�99�� ���������� <br />��JI��I��If���C��9�0���./PL�Ii��IIV�/�I�I�/S��I����R/D�6VI��1�'dO�l <br />CITY OF EVERETT P�RPiilli SERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />PROPERTYTAX#1 I �+� i�G�'C' <br />51TE ADDRESS: v � <br />/tl Z5 S� �ie��T�` n�1�-l-L �/o�� <br />_�GAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng lega) description) <br />ER �� �� .� <br />PhonelE-mail � �%7 � �`�J�X`��� <br />ress �(j(_'� pi �-� j}�� �City/State/ZiP E2slc T I�Zl�i,� i� /�x' <br />'LICANT: Owner _ Owner's Agent ^ Contractor �Contractor'S Age�t _ TeTlallt (musi provida a Istter of consenl from the owner lo dp work In ihe space) <br />�� � c IState Lic. # <br />NTRACTOR I Fi �.�L- e� 5' ��.vt S�;�IfiC'6' � <br />ress <br />�� (' (S� i.�1 • ��5��'vo _ P i�% t�N � �T �-��-L <br />City Bus. l.ic. # <br />al� i �L~fCJ ��'7 ' <br />l f_' J� jf/ s �"�/��'--�'—i.�,�%'✓t�� <br />�% �l` -�., �_; v1 j�,,2Ts Phone/E-mail .�(� .�'�����L�R <br />BUILDING PERMIT APPLICATION cONTRACT PRICE OF WORK <br />Existing Use of Bullding �� ���` L <br />Proposed Use of Buiiding � ��� �L <br />Building type; � Singie Family _ Duplex _Townhouse _ Muiti-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 />� i �; �; � 1/, ,,•�� F� 7'v ,� � t�c !�C'�"y.ne-,ri7 � �TS ����7 <br />1 �l S %r(J� . <br />Type of Project: _New _Addn �Aitera <br />Show Number (#) of fixtures <br />A/C — air handlin <br />Forced air syster <br />Gas pipin4 <br />SPRInI <br />d <br />_Repair <br />units <br />Other <br />/ SUPP9�ESSIOR! <br />Number of Heads <br />HEAT SOURCE: <br />of Use <br />� eP�.�C��t''�l�' /cv�_ <br />of Project: _New _Addn ,_,Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />er <br />Water <br />Sink (: <br />Backfl� <br />rioor arain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other <br />osa <br />I he�epy certify that I have read and examined this application and know ihe same to be irue and correct. All provisions of laws and ordinances governing lhis iype of work will be complied <br />wiih whether specified herein or not. The granting of a permit does not presume io give authority to violate or cancel ihe provision of any other slate or local law regulating consiruclion <br />That I am authorized by ihe owner of this property to perform the work for which a plicaf n is made and I comply with the State Contractors Law 18.27 RCW and 296.2ooA WAC. <br />� i , <br />� � ����� p� (Revised 4/2015) <br />O ner/Autho i A ent5ignature <br />, �� <br />