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����I� ���������� <br />��J1��1��/�1��6���ICA��,/PL�li��ItVG/�I�IN/���1i�1���R/D�6�i��,l`f wON <br />CITY OF EVERETT PERIVIIT SEF�VICE� <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ITE ADDRESS: % s'('Lt� j PROPERNTAX # E MIT #, <br />�(��.��f �Zo� K�►=����/� �-v��� ��r�� �''�1��e1'��' <br />�GAL for new construction: Shori PlaUsubdivision Lot No. {attach copy of long legal description) <br />dER � �";�,� •7�'" (,.�,� T� ' v - /r (: /�-jS"/"_ PhonelE-mail <br />;ss ,Z 47� y �c'C � kLi-�l� ,t /-� F� � �'f �!'Z.c j City/5tate/Zip � �, �t'/,�!� iT � �Lti <br />LICANT: _ Owner _ Owner's Agent _ Contractor �. Contractor's Age�t _ Tenant (must provide a le�ler of consant from the owner to dp work In the space) <br />�? 7'!S" ��i i�• <br />cvli <br />c1.+r y>'�� C if u 2 cr�- c� �,�, s; <br />BUILDING PERMIT APPLICATION <br />State Lic. #�J� 1{-nJ S(> xr <br />�`� �� Z i I Phone/Email �t! 2„ ��� <br />Clty Bus. Lic. # �i'';Z <br />_ �r %�, �; <br />�� Z� � 't/�il -�i SS � J7ri//�� .� <br />Phone/E-mail J�N . �' � C ,� �' � � <br />CONTRACT PRICE OF WORK �%, �7 �`� I <br />Existing Use of Bullding C���i H <br />Proposed Use of Building L%�I�QC� �� <br />Building type; � Single Family _ Duplex _.Townhouse _ Multi-Family _ Commercial <br />Type of project' New Addition �emodel Repair T.1. _ Sign _Sprinkler <br />HEAT SOURCE: <br />✓ Flectrir. �. <br />olition_Change of Use <br />DESCRIPTION OF WORK (add�tional space prov�ded on the back). ,��� S <br />/NSr��- � ! ���Ti.v� �;,�i 1" i nl � L� �: r.' � i (� Z,h i,�.,.ir"T 'T7� Y+T L <br />�?���.-��� . �-c� s�� � �PL�a���� i �x Nfti.�ri" �=�a�v , <br />Type of Project: _New _Addn ✓ Altera <br />Show Number (#) of fixfures <br />A/C — air handlin <br />i Forced air svster <br />Wat�r heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />_Repair <br />units <br />— � Ducting <br />� Other <br />SPRIN�(I.E1� / SIJPF'ItESS10►d <br />Number of Heads <br />Type of Project: _New _Addn ,_,Alteration _Repair <br />Show Number (#) of Fxtures <br />I Toilet <br />Dishwasher <br />Clothes washe� <br />Water heater <br />Sink (service/bar/ <br />Backflow prevent� <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I he�eby cerfify that I have read and examined ihis applfcation and know ihe same to be true and correct All provisions of laws and ordinances governing ihis iype of work will be complied <br />with whelher specified herein o ot. The granting of a permit does noi presume to give authority to violale or cancel the proVision of an)� other slaie or local law regulaiing conslruclion <br />That I am authori d by er of this property to perform the Work for which application is made and I comply with ihe State Contractors Law 1827 RCW and 296.200A WAC. <br />� "3 � - ( S�� , <br />Ownerl uth zed gent Signature Date (Revised 4/2015) <br />. � <br />