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• • <br />����0� �l�"I!-"�U�� U I➢Q� <br />�������������������������I���������������������������� <br />' CITY oF El1EF�ETT P�Ri�il`� SER\/ICES <br />3200 Cedar St., �verett, WA �82�1 �}25-257-8810 FAX 425-257-8857 www.everetiwa.org <br />SITE AD �ESS: � A PROPERTYTAX # P�,,f� MIT # ^ -� <br />� 1 Z`�il,� b�b'Li �.%C �i l'G� n Y� � VI .� ��" C` �� <br />L�GAL for new construction: 5hort PlaVsubdivision Lot No. (attach copy of Ibng legal description) <br />OWNER�.P�.�N�lL. �j� ��-i' 6)LSc>Y✓1��- Phone/E-mail i-12.�-272- �(� j� <br />Address "l 2 ^�l,r�lLi �.'£ �,� i � c.J C� $�Ll. � City/5tate/ZiP L" U ��1t r-r.' � � �� �° i . <br />AFPLICANT: _ Owner _ Owner's Agent _ Contfacto� _ Contfactor's Agent _ Tenant (musi provida a leuer of conseN irom �he owner la dp work In the space) <br />CONTRACTOR �`����;��L=-� �7Z-A�.i� -j'_✓��f <br />Address 2 �1"Zi, �G�FI.� (�l,l r-� � � �1:r12�T`� <br />f� . �.,� : C�"�`Cb%YI- �'L' vZ � l r G� IJ ��i c> ✓✓J �tii <br />BUI�.DING PERMIT APPLICATION <br />State Lic, #�.�E�-�`'C�?Z'�Ea C� City Bus, Lic. # <br />� � ¢� ( Phone/Email � Z'j •- 'Z°`�'Z � C � � <br />CONI'ACT FQR PERMIT <br />N1�1►41,��,�' �S >��t uJ.� . �'� <br />Phone/E-mail �Z '2-�2��« <br />CONTRACT PRICE OF WORK I �' <br />Fxisting Use of Bullding P��� C..��2'"(.�� - E"��E�'`�'` � <br />Proposed Use of Building �, ��-��'``�� <br />Building fype; � Single Family _ Duplex_Townhouse _ Multi-Family _ Commercial <br />Type of project: New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler <br />' d b k' <br />HEAT 50URCE: <br />Gas Electric X � <br />emolition Chanqe of Use <br />DESCRIPTION OF WORK (add�honal space prowde on the , ac ). <br />l�� b2 �;}c.�`7i � N� -� ��E'� � M«�-{'��5 k� �� uCT�-G� 5 i,t,+ �'Tr� �� ���.,L L(� L WC. �t.� cCG u�, <br />(�Pr�'�t� ; Lv �� �c,=t�v <br />CA <br />ofProject: _New_Addn _Alteration,�Repair <br />5how Number (#) of fixfures <br />A/C - air handling units <br />Forced air systems <br />SP}$1� <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />�efrigeration <br />Noodstove <br />Other <br />� �l1PIP�3I���DOY�9 ��(�`���II <br />Number of Heads <br />MB <br />TIO <br />of Projecf: _,New _Addn ^Alteration _Repair <br />5how Number (#) of fixtures <br />I Toilet <br />l.avatory (wash basin). <br />Shower <br />Kitchen sink & disposal <br />Dishwasher ' <br />Clothes washer � <br />Water heater <br />Sink (service/bar/mop/etc,) <br />Backflow preventer' (inside b <br />Drinking Fountain <br />Floor drain <br />G�ease frap <br />Ropf drains ' � <br />Medical Gas <br />Other: <br />Other; <br />I herepy certifyiftat I have read and examined ihis 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 whefher specified herein or not, The graniing of a permit does noi presume to give authority to vlolate or cancel ihe provision of any other siaie or local law regulating conslruction <br />Th E�f�m aulho�ized by ihe ownet of this property to perform the Wo�k fo�which application is made and I comply with the State Cant�acto�s Law 18.27 RCW and 296200A WAC. <br />� ` ;, — <br />l�–/ —/ <br />Owner/Authorized�l, nt �gnature Date (Revfsed4/2015) <br />/ <br />