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■ '.� `, /, I�> ��1 k I i �; j'`� � �" ��' "p �` <br />; <br />�. , <br />, __ . , , __ _ _ <br />�IJII��IRI�/I1�����NIC�A�/PLt�tV��IIVG/SI��V/��RIRII��ER/D��O�,IiIOi� <br />� CITY OF EVERETT P�RMII' SERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />� PROPERTY TAX # <br />i�,�'���G/�� �,�C�� �_ � �v y��c � <br /># <br />. /� �.+G' . <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />OWNER`}'?✓%;�2 ,�/�/�l/��/'� ��� PhonelE-mail /�/"7l�'L�Cu' � ��CC�1�5 CG, <br />address '7 `J _'1 � i�'/� /�/,L'%/'�� i f�/�� c�ryistateizip ��>�'/'���- ��f� . �r"�, �1C) <br />ICANT: � Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant (mu5t provida a iener of �onsan� rrom me owner �o aP woric in me spa�e� <br />�R � //CL` �C�`C �CY7���� J Stafe Lic. # �Z,��/�C'C� £'iP-� ��City Bus. Lic. # <br />`� �C� �� _ %7��%�/.. �� �/`/�.— ����/.Y� GC�� � Phone/Email � �� '"lc-`l./�� —! ll�� <br />, CONTACT FqR PERMIT � <br />'�y`.��..e� �a <br />C�!l �' «� C�L �/��/G � L�� � <br />BUILDING PERMIT APPLICATION <br />Phone/E-mail ��� �� � > ����� �_ <br />CONTRACT PRICE OF WORK �%/, ���- f� <br />Existing Use of Building �?l ��/ �C����'— _ HEAT SOURCE: <br />Rroposed Use of Building %�.���C��`�C����� _ �as Electric_ other <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family �Commercial <br />Type of project' New Addition Remodel Repair T.I. Sign Sprinkler Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : c, <br />� � � %�� -�-t��i'�"�i',. �.�',.�'� .'l ���`��i�� /�'C� C.,�'�z'T'�'< � <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <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 />SPRIf�aCLER / SUPPRESSIOM SYSTEM <br />Number of Heads <br />ofP.roject: _New_Addn � Alteration'_Repair <br />'� � ' Show Nu�Obei'�'�1 �bf �Xtures�-�" <br />I Toilet <br />chen sink & di: <br />�hwasher <br />>thes washer <br />ater heater <br />ik (service/bar/ <br />�kflow prevent� <br />nal <br />nkina Fountain <br />�rease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hefeby certify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and ordinances governing this type of work will be complied <br />wiih whelher specified herein or not. The granting of a permit does noi presume to give authority to violate or cancel the provision of any other staie or local laW regulating construcllon <br />That I am authorized by ihe owner of this prop to p orm the w k for which application is made and I comply With the State Contractors Law 18.27 RCW and 296.200A WAC. <br />i � <br />� �� ,���/' -� r �'/��� C� � /,�� <br />� /� � ,' ; `' ` , <br />Owner/Authorized Age ature Date (Revised 4/2015) <br />I �2_ <br />