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• � <br />���.G�a`� ���aa�,/��Q �@I� <br />��Q��������������,��������o����a��r���a�����������o���� <br />' CITY OF E1lEREiT P�Rfiiill� SER�/ICES <br />3200 Cedar St., �verett, WA �82�1 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ITE ADDRESS: <br />`� `'r � � �i � ��r . <br />;GAL for new construction: 5hort PlaUsubdivisio <br />OWNER � I F`��.�1C,�'a� <br />Address ?"� � � C ie.����� <br />APPLICANT: _ Owner _�Owner's Agent _ Contractor <br />CTOR ��� ����EG:-� ��Z-PcTi <br />2�2u ����� �G. �v <br />PROPERTY TAX # I P�jfjM�� �� s�� <br />� �l <br />Lot No. (attach copy of Ibng legal descriptiDn) ' <br />. �`} �^ i,� � <br />Phone/E-mail � 2-� �� c%S <br />City/State/Zip � `�l���� L��� c�'� ZL� <br />Contfactof's Age�t J Tenant (must pravida a letfer of consenl fram the owner �o dp work In the space) <br />',�jj� State Lic, #�,j1����?LZ� l� City sus, L.ic. #�c:� <br />�.(.� � � � ( PhonelEmaii � Zj •- 'Z�'Z � �, � <br />�� i�L�; � rc�a � a�.��-� �' �s;,�►w�,� =�-M <br />Phone/E-mail � -Z�i-i(l * <br />BUI�.DING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Fxisting Use of Bullding �� �-����%ti1 HEAT SOURCE: <br />Froposed Use of Building L� �' �--�Lf� � �as� Electric_ other <br />Building fype: � Single Family _, Duplex _Townhouse ,_ Multi-Family � Commercial <br />Type of project: _ New Addition _ Remodel rC Repair_T.I. _ Sign _Sprinkler_Demolition_Change Df Use <br />DESCRIPTI�N OF WORK additional space provided on the back): <br />�� � Z�����' t�� f��� �'�-c� w1 i-��C�� 5�3e � l�'1 �. �11 z-a�,� �,,�°,°� u'� �k> �a�` <br />.� � <br />�-�i�Y►-x.% ��!"�' ���,t�.� ��-�r .-��✓��.:�, �'���r������ <br />APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handlinq unifs <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Ciothes dryer <br />Range hood <br />Exhaust fan <br />Heai pump <br />Unit heater <br />Boiler <br />Refriqeration <br />SPI�Ift���.ER / ��1PlP�f���llOY�'I ��(�`�� <br />Number of Heads <br />P <br />TIO <br />Type of Project: _,New _Addn ,^Alteration _Repair <br />5how Number (#J of fixfures <br />I Toilet <br />Lavafory (wash basin <br />Shower <br />Kitchen sink & dispos <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (selvice/bar/moF <br />Bacl<flow preventer (ir <br />Urinal � <br />Drinl<ing Fountain <br />Floor drain <br />Gfease trap <br />Roqf drains ' � <br />Medlcal Gas <br />Other: <br />Other; <br />I he�eby ce�fify that I have read and examined ihis appllcation and know ihe same to be true and correct. All provisions of laws and ordinances governing this lype of work will be compiied <br />wilh whe�her specified herein or not. The granting of a permit does not presume io give authonty to violate or cancel ihe provision of any other siate or local law regulating construction <br />That I authorized by ihe ovrne� of this property to perform the Wo�k for which application is made and I comply with ihe Siate Contractofs Law 1o27 RCW and 2962DOA WAC. <br />�`l��`�� >l � i 5 <br />Qvrnsr/Authori d ent Signature Date (FZevised 4/2015) <br />�� � � ��z <br />