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�ERIVIIT APPLlC�4,T1 N <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOL,ITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: PROPERTY TAX # P RMIT # <br />S � , �����- 64- � oos� 3 3�` �oo - <br />L�GAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />OWNER � �Zr" Phone/E-mail ��.� 3Y3—y'��f�% S�eP�.e►'��S'e �� K•� ce�,� <br />Address ���(( ( �" S� City/State/Zip ���-�.�� (,Jt�{- �'(�.Z� p <br />APPLICANT: �Owner _ Owner's Agent _ Contractor _ Contractor�5 Age�l _ TBfl2flf (must provide a letter of consent from the owner to dp work in the space) <br />CONTRACTOR /L���- <br />ress <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />CONT FOR�MIT <br />� � ""�- V �`� . <br />Phone/E-mail (,�Ls-3C�j--1� <br />CONTRACT PRICE OF WORK <br />Bus. Lic. # <br />�0�1 L'✓igem�/ T�'� <br />� <br />� 4F1✓Yl�t� �' Gd"Lai <br />Existing Use of Building _�H '��1��• �-�l ��j r� HEAT SOURCE: <br />Proposed Use of Building����►'1 � �� ���-�2 Gas_ Eiectric_ other <br />Building type: �Single Family _ Duplex _Townhous _ Multi-Family � Commercial <br />Type of project: New _ Addition. �}el _ Repair _ T.I. _ Sign _Sprinkler Demolition_Change of Use <br />DESCRIPTION O WORK additional s ac ow ed on the b ck) : <br />� e�,�%`�� �-�-- �'� �n� b��. � � ��a����Y �►��� ����,.,s� <br />J ° <br />ccP� ����es r �': ��c-S � e �c . �%� � � C���y ��v►� � y . <br />of Project: _New _Addn _Alteration _Repair <br />Show Num6er (#) of fixfures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />V Water heater <br />�' Gas fireolace <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeration <br />� Other <br />RINKLER / SUPPRESSI <br />I Number of Heads <br />SYSTEM <br />Type of Project: _New _Addn _,Alteration _Repair <br />Show Number (#) of fixtures <br />d I Toilet <br />sh basin <br />�nower <br />Kitchen sink <br />Dishwasher <br />Backflow preventer (inside <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this iype of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume io give authority to violate or cancel the provision of any other staie or local law regulating construction <br />That I am auihorized by ihe owner o is r �fo�hich application is made�ndacoritpty with the State Contractors Law 18.27 RCW and 296200A WAC. <br />� — <br />_ <br />� z� � _ _ _�_ _— <br />Ow rlAuthoriz Agent S gnature Date (Revised 4/2015) <br />