Laserfiche WebLink
• �� ���L�����Q���'J <br />���� <br />�����I���������Q���������0��1��I������5���������������� <br />' CITY OF EVERETT P�RMIT' SERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRE$$: IPROPERTYTAX # I .�^K;����� � ��� <br />'%�.`� � t:_i `J `s /��' � ' r �� � � <br />L�GAL for new construction, Short Plat/subdivision Lot No, (attach copy of Ibng legal description) <br />OWNER �` yl�! � �� Phone/E-mail �,�,;.- •� �i 4 ��� <br />� <br />Add�ess �Z,�'� ��j `!�,` City/State2ip �.�r�y't,("f" 'i ,j'�?fJ/ <br />APPLICANT: Owner _ Owner's Agent �, Contractor _ Contractor�s Age�t _ Ter7aflt (must provido a le4er of consenl from lhe owner lo dp work In Ihe space) <br />CTOR �'������1=�L� G7�PcTi <br />2 r2u �-�F��- +� c . � � <br />�f��- �i�✓�-fl/-IvE.�i�J <br />BUI�.DING PERMIT APPLICATION <br />State Lic, #�,�Et�-�CiL'ZE%' l City Sus. Lic. # pc�'7���2j <br />� � � � Phone/Email �- Z� •- 'Z�2 � l,'� <br />�i��^�': ��%�'���;�A. ���� <br />Phone/E-mail � Z'� -Z5�'" ��lU <br />CONTRACT PRICE OF WORK �, �CXi <br />�Existing Use of Building l'�TJ �,ei�'��� HEAT 50URCE: <br />Proposed Use of Building C' �� ���� � Gas_ Electric� Other <br />Building type; ^ Single Family _ Duplex _Townhouse _ Multi-Family ?C Commercial <br />Type of project' New Addition Remodel C� Repair T.I. Sign Sprinkler Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): � <br />(Z � � �� �� Ct,�►�.v,u� � ��� U.��t-�-- �►-� ��,�+�' ��� ��i����c.dl = �}�1� 7���- <br />t�J i:�a�-�Y �'�� /ti-� /��/ <br />EC <br />L:J <br />of Project: _New _Addn _Alteration _Repair <br />5how Number (#) offixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />uas range <br />Clothes drye� <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Ductinq <br />SPI�I���.EF� / S�1PPQ3��SdOPd �l(�`�EGlil <br />Number of Heads <br />P <br />of Project: _,New _Addn ,_._,Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />Snower <br />Kitchen sink & disposal <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer (ins <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 certify thal I have read and examined ihis appllcation and know the same to be irue and correct. All provisions of laws and ordinances governing this lype of work will be complied <br />wilh whelher specified herein or not. The granting of a permit does noi presume (o give authority to violate or cancel ihe provision of any other siaie or local law regulating consiruction <br />That I am \orized by the owner of this property to perform the work for which application is made and I comply wiih the Siate Contractors Law 1827 RCW and 296200A WAC. <br />�` - 2� -t � <br />Owner/Authorize ent Signature Date (Revised 4/2015) <br />