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����.�o��.r���a�a�� <br />���������������u������������r�i������a�a����������a���� <br />� CITY OE EVEREiI" P�}�f�fi1T SIERVICE� <br />3200 Cedar 5t., �verett, WA �8201 �425-257-881 D FAX 425-257-8857 www•everettwa.org <br />PERTY TAX # <br />PERMIT <br />� <br />J � L_ - � ' � �`ol� . <br />L�GAL for new construction, Short PlaUsubdivision Lot No, (attach copy of Ibng legal description) <br />OWNER � //� )L ) ( '� z-1 ��-L. �� ' � Phone/E-mail , /�C�� . - /'� � _ , � <br />d�BSS (�, li ��. �.. , 7 C: _ . � _ .y, ..� ,�,r. JG � '_ _ . . . <br />'PLIGANT: Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant {must provida a le4er ot consBnt froin �he owner to dp wo�c In �he space) <br />C <br />BUI�DING PERMIT APPLICATION <br />State Lic, # <br />Phone/E-mail <br />CONTRACT PR10E OF 1NORK <br />Existing Use of Bullding �� �T �� "?�� � � <br />Froposed Use of Building <br />Building type; � Single Fainily �Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of p[oject: _ New _ Addition _ Remodel _ Repait _ T.I. _ 5ign _Sprinkle <br />DESCRIPTIOAI OF WORK (additional space provided on the back) : <br />���� ���u� ���� ���� - <br />� <br />ofProje�t: _New_Addn _Alteration,,_Repair <br />5how Num6er (#) of iixtures <br />A/C — air handiing 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 />( Botler <br />� Refrigefation <br />� Woodstove <br />� Ductmg. <br />� Other • <br />SPRI�I���lf� I ��PP�I���flOBd ��iS`d"�M <br />Number of Heads <br />� City Bus. �.ic. # <br />� <br />� -% <br />HEAT SOURCE: <br />_ Electric��ther <br />olition Chan4e of Use <br />of Project: _New _l�ddn ,_Alteration _Repair <br />Show Number (#) of �xfures <br />I Toilet � _ <br />l.aYafory (wash basin). <br />Sliower <br />Kitchen sink 8� disposa <br />Dishwasher ' <br />Clothes washe� <br />Wafei heater <br />Sink (service/bar/mop/� <br />Backflow preventef (in; <br />Urinal � <br />Qrinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains � ' � <br />Medical Gas <br />Other: <br />Other: <br />I hefeby cerfify that I have read and examined ihis appllcation and know {he same to be true and correct AU provisions of laws and ordinances goVerning thls iype of work Will be co�nplied <br />wiih whe�her specified herein or not, 7he graniing of a permil does noi presume (o give authority io violate or cancel ihe provision of any other siate or local law regulating consiruclion <br />That I am authorized by the owner of this property to petform the wark forwhich application is made and I comply with the State Coniraetors LaW 1 �27 RCW and 296.20oA WAC. <br />�� / c �;��� ,� i� �9 ���'� , <br />' � '` ` >'� � ' —'y` - N " Date (Revised 4/2015) <br />OwnerlAuthorize Agent Signature <br />