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•r����������a����� <br />���������������o��������������a����������������������� <br />' CITY OF EVEREI'T P�RM1T SIERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />RTY TAX # <br />for new construction: Short PlaUsubdivision Lot No, (attach copy of long legal description) <br />,� .� i �U � <br />ICANT' Owner _ <br />CONTRACTOR ���–� <br />Address ( � Z-� f7 ,, S ) <br />� <br />Phone/E-mail �Zj =--cjC„', —' l ( G/ <br />Giiy/StatefZip �v� �."'� <br />Agent _ Contractor _ Contractor�s Age�t _ Tellaflt (must provida a letler of consenl from the owner to dp work In Ihe space) <br />''L�: ,,.�.� � � <br />State L'Ic, # <br />j�`�=�Phone/Email �.�j� <br />city Sus. Lic. # (� <br />� <br />. .r...,...___ ._....._ ��Fx,S'iZ� ��''�� <br />��;t�"�– � Phone/E-mail .p'--- i✓_S � (�� �cu � � ,J. S�• <br />BUILDING PERMIT APPLICATION coNTr�cT PRicE oF woR� ��� � ` � �Y <br />Existing Use of Bullding `r%�- HEAT SOURCE: <br />Froposed Use of Building � �as� Electri� other <br />Building type: � Single Family _ Duplex Townhouse _,�, Multi-Family _ Commercial <br />Type of project: New _ Addition _ Remod Repai �_ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />D CRIPTION OF WORK (additional space provided on iheb�ck) : <br />�CQW�1N- c� '� \'1.� �/�vv►o4Cta' i K �T�-a.�,is % %�� � � w'Y�►- �l)S�l-� %� �'Lu�S <br />W 1 ` � I� �vv4 ct� '� 7� �� u6 <br />� <br />'� (�; C��. �tl � '��-�4-� �.� �. �F�456 7 <br />Type of Project: _New _Addn _Alteretion _Repair <br />Show Number (#) of fixtures <br />A/C – air handling units <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryel' <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />of Project: _,New _Addn �,Alteration _Repair <br />Show Number (#) of fixtures <br />Kltchen sink & disposal <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/badmop/et <br />Backfloinr preventer (insi� <br />llrinal � - <br />Drinking Fountain <br />Floor drain <br />► Ducting � Koot arains <br />� Other Medical Gas <br />S�'R1PdIKI�ER / SIJ�'P9�ESSIOPd ��(STEM Other: <br />Number of Heads Other; . _ <br />I hereby ce ify th t I ave read and exa ined ihis appllcation and know ihe same to be true and correct. All provisions of laws and ordinances governing lhis lype of work will be complied <br />wiih whei er sp if d herein or not, e granting of a permii does not presume to give authority io violate or cancel ihe provision of any other siaie or local law regulating construction <br />That I� uiho by t� owner o� property io perform the work for which application is made and I comply with ihe Siate Contractofs Law 18.27 RCW and 296.200A WAC. <br />l� lI i i <br />(Revised 4/2015) <br />