Laserfiche WebLink
�"�'�:;;� i ,r�F''[���C� I IC� <br />[��9��1��/9���1���91�,s��/�����IN�/�I�I�/���5���,��/��6�����'��� <br />� CITY OF EVEREiT P�Rf1f11T' SERVICES <br />3200 Cedar St., �verett, WA 982�1 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />;ESS: <br />L�GAL for new construction: Short <br />PROPERTYTA7C# <br />�, �' 7 ?Z�tv7`t <br />Lot No. <br />PERMIT # <br />{attach copy of Ibng legal descripti�n) <br />J <br />ER ���� ���+'�`7� i�������� lV��/r Phone/E-mail <br />�5 �Z�S��'S 3��'t �L L� City/5tate/Zip j�,�-'/cyL ��iA ��c' �, <br />JCANT: _ Owner _ Owfle�'s AgeTlt _ Co�tfactof _ ContfaCtof's Age�t _ Te�aflt (must provida a le�ter of consoN from the owner Io dp work In the space) <br />�1����*�� <br />ress �1"Z� <br />1�'�1.� G . �v:-�2�� <br />�✓�C- t �( L �' V � �[�'%� % <br />BUI�.DING PERMIT APPLICATION <br />Existing Use of Bullding Nv <br />State Lic. #���t��CiZZE� l City Bus. L.ic. # pv <br />� � �.E1( Phone/Email � Zj � 'Z�`Z � ( � t/ <br />CONTAC�' FQR PERMIT <br />��y�(� C' �,>�-n �A. r�v� <br />Phone/E-mail Z. j—� j 2��' �� <br />CONTRACT PRICE OF WORK ���, �' �' `� <br />HEAT S�URCE: <br />IProposed Use of Building tJ� �'���' 4 I Gas� Electri <br />Building type: ^ Singie Family _ Quplex _Townhouse _ Muiti-Family ?� Commercial <br />Type of project: _ New _Addition ,_ Remodel i� Repair_T.I. _ 5ign _Sprinkier_Demolition_ <br />AESCRIPTION OF WORK (additivnal space provided on the 6ack): <br />� t. �2 zrv �� ���� 5 � � �, ��--���—rt�t <br />�U(.�) ��r�.-�� = 7C( GG� 5 �.1� f�'�u�� �G�Y� �s <br />PLI <br />ofProject: _New_Addn _Alteration,�Repair <br />Show Number (#) of fixfu�es <br />A/C — air handling units <br />° Forced air systems <br />Gas piping <br />Water heater <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />nit heater <br />oiler <br />Woodstove <br />� Other <br />Sialgl�G��.E1� / Sl1Q'PQ��SS�OYd S�(�`��Elil <br />Number of Heads <br />BING <br />Df Use <br />of Project: �New _Addn �Alteration _Repair <br />Sho�v Number (#) of fixtures <br />I l"oilet <br />5nower <br />Kitchen sink <br />Dishwasher <br />Clothes was <br />a <br />�rease [rap <br />Roof drains <br />Med'Ical Gas <br />Other: <br />Other: <br />al <br />I hereby certify that I have read and examined this appllcation and know the same to be lrue and correct. All provisfons of laws and ordinances governing this lype of work will be complied <br />wiih whether specified herein or not. The granting of a permit does not presume io give authority to vlolate or cancel ihe provision of any other state or local law regulating consiruction <br />That I a �ihorized by ihe owner of this property to perform the wo�k fo� which application is made and I comply with ihe State Cont�acto�s Law 1o.27 RCW and 296.20DA WAC. <br />� L� � �(-� ._�'_ l S <br />-Barrte�r/Authorj e Agen Signature Date (Revised4/2015) <br />. � ( �, <br />