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� � ~ r'; r ;. E � r� `� � � I C /`��'� 1 ! �� k `�� <br />�����i����n���������������i����s��r���e����������,��w�� <br />' CITY OF EVERETT P�RM1T SERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />TAX # <br /># <br />L�GAL for new construction: 5hort Platlsubdivision Lot No. (attach copy of Ibng legal description) <br />� 1 ' , <br />�ER Y�'(%'�_ `,� �� PhonelE-mail ZD4� � �J� J` ' «,-a� . �t-�� ' <br />:ss (")0..�5 City/5tate/Zip " �T �'� �1 ��' � " G <br />LICANT: Owner _ Owner's Agent ��ontractor _ Contractor�s A9e�i _ TeflBflf (must provide a letter of consenl frvm Ihe owne� to dp work In the space) <br />�� <br />� ( � vn YJ C r� <br />�- �'�� � <br />BUI�.DING PERMIT APPLICATION <br />Existing Use of Building <br />r <br />���. # �( � , D// P �� � c�� sus. ���. # �S-� <br />Phone/Email � ZS � � � � — � � Z � <br />1CT FQR PERMI I / L.L t- <br />�, /-z- � S %�%¢ �'r ° i-'�� t rl c�., <br />-mail / � 2"� � T � / - � � z. � <br />ONTRACT PRICE OF WORK <br />Proposed Use of Building � <br />Building type: �ingle Fami�y _ Duplex Townhouse _ Multi-Family � Commercial <br />Type of project:�_ New _Addition _ Remodel _ Repair_ T.I. _ Si9n _Sprinkler <br />DESCRIPTION OF WORK (additional space provlded on the back) : <br />K—UZ= � �l 1 r� � • �J 'p � �- � � � �--`�'`ti- l 1'\ � r�4-�-e-�ti'e__.�-� <br />�� <br />Type of Project: _New _,Addn _Alteration _Repair <br />5how Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <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 />{ Refrigeration <br />� Woodstove <br />� Ducting <br />. � Other <br />SPR1IdaCILER / SUPPRESSIOPd �l(Si <br />Number of Heads <br />HEAT SOURCE: <br />of Use <br />Type of Project: _New _Addn ,_,Alteration _Repair <br />Show Number (#) of fixtures <br />i Toilet _ <br />al <br />rioor�rain <br />Grease trap <br />Raof drains <br />Medical Gas <br />Other: <br />OtheT: <br />I hereby certify th have read and examined this application and know the same to be irue and correcL All provisfons of laws and ordinances governing ihis lype of work will be complied <br />wiih whether ec' erein o� not. The gra�ting of a pe�rnit does noi presume to give authority io violate or cancel ihe provision of any othe� state o� local IaW regulating conslructlon <br />That I am a ri by ih owner of this property to perform the wark for wh7ch application is made and I comply with the State Contractors Law 18.27 RCW and 296.20DA WAC. <br />/v /U �- / � �-/�-' <br />Owner thorized Agent Signature Date (Revlsed 4/2015) <br />