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• y �� <br />���1�9�� �������� <br />��'�.������������������,��������i�������������������,1���� <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 />�, , � �-,..�,..�.. <br />� � i i��a�-�,fl� _ <br />L�GAL for new construction, Short PlaUsub <br />OWNER ll�G � <br />d�ess��G�l� I�cc.-k�fr I I�',/" �VL�- <br />'PLICANT: '� Owner _ Owner's Agent _ Contractor <br />TOR <br />BUILDING PERMIT APPLICATION <br />PROPERNTAX# P RNI�T# <br />a��(:38f 3��C� �:Svp ��� l �f�,� <br />Lot No. (attach copy of Ibng legal description) <br />PhonelE-mail Z 5 Z�Lj (p!'�RC j�i Z� .� y 7 �� Z� <br />City/State/ZiP r� �e.' E' ,,v�f_1 �,�j(�� <br />COntfBCtof'S Age�t _ Te�aflt (musl provida a leller of consent from the owner lo dp work In the space) <br />State Lic. # City Bus. l.ic. # <br />Phone/Email <br />CONTACT FOR PERMIJ C �� <br />��Cl���'� � �5' c✓ C11'►'ZGt� � <br />Phone/E-mail � Z S �Z �� U(�C: S'' U <br />CONTRACT PRICE OF WORK �I.I `-� � z--� ���� <br />Existing Use of Building �7 t�- � ���'"` �� �� ��-'�� HEAT SOURCE: <br />Rroposed Use ofBuilding �� 1�.. �-''"� �� ���5(G�1C.� Gas_ Electric_ � <br />Building type: ^ Single Family _ Duplex _,Townhouse _ Multi-Family _ Commercial <br />Type of project: New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />�(t',)��� � ����`�� Ic 21'�C 1� r <br />� r <br />NICAL PERMI <br />Type of Project: _New _Addn _Alteration _Repair <br />5how Number (#) of fixtures <br />A/C — air handling units <br />�ter <br />ace <br />as ra <br />t�cange nooc <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeratioi <br />� Other <br />SPRIN�(L.ER / SUPP�ZESSIOR! SYSTEM <br />Number of Heads <br />P <br />of Use <br />of Project: _New _Addn ,_,Alteration _Repair <br />Show Number (#) of fixtures <br />1 Toilet <br />Kitchen sink & dispo: <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/bar/moF <br />Backflow preventer (i <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains � <br />Medical Gas <br />Other: <br />Other; <br />I hereby certi(y thai I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this lype of work will be complied <br />with whelher specifi�d herein or not. The granting of a permit does noi presume to give authority to violate or cancel ihe provision of any other state or local law regulaiing construction <br />Thai I am authofized by the owner of th�,prDp to perform the work for which application is made and I comply with the Siate Contractofs Law 18.27 RCW and 296.2DOA WAC. <br />;' '/_ � --...___ ..... <br />,. V' _ :-' .,. <br />Ownet/Authorized �e SignatYire Date (Revised 4/2075) <br />l/ <br />Z <br />