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���n�i�����ac��ri� <br />�IJILDING/�ViECHANIC�L./PL.lJiU1�ING/SIGN/SPRIIVf�LER/DEti�OL,llf ION <br />CITY OF EVERETT PERMIT' SERVICE� <br />3200 Cedar St., �verett, WA 982�1 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: ,r_ PROPERTY TAX # �,� PERMIT # <br />�1�. 1��� �aw��e /��� <<C��ti� � ���,�,��,��rac,� � I����1���� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />OWNER �{�Qy'1'T �c�rlt��r�,t:.'i ��� Phone/E-mail —1Z�,SIZ.�4�1�� �v���/1(�'C�',i.j�lr�y��,�����C <br />Address C) � � L �-� � c��.v:�!'c? %� \/�- City/5tate/Zip ��/G�.� �il V{��� C� v ��'� <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ Contractor�5 AJ8f7t _ Te�2�t (must provida a letter of consent from Ihe owner to dp work tn the space) <br />ONTRACTOR C�,'�; <br />dress <br />Lic, # <br />Phone/Email <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building �'�S I C�r1 � i�J � <br />Proposed Use of Building �'� � 5��� r►a I G� <br />Building type: %� Single Family _ Duplex _Townhouse _ Multi-Family ^ Commercial <br />Type of project: New _ Addition _ Remodel _ Repair � T.I. _ Sign _Sprinkler _C <br />DESCRIPTION OF WORK (additional space provided on the back): <br />Clty SLIS. �.IC. # <br />fi� i�) . s 1�'� CS <br />HEAT SOURCE: <br />Chanae of Use <br />Cvll�t'_t i' tX �S�"i��� �r?ili�t��n �� ���f'h�'Jt�<�1 . �'i(� �-11v+� �►�, •'!�� c`3i C. c'.�.5 f �+i�- <br />'�f 17 �'�'1 �-�`r :� Gt �� ��1 � i� �t,') yc ,� z,� fi. <br />nn�r_Ner►t�r�e� PFRMIT �PPLICL►TION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />SPRIN <br />Gas range <br />Clothes dr <br />Ranqe hoc <br />it heater <br />iler <br />Ducting <br />Other <br />R / StJPPRESSION SY�TEM <br />Number of Heads <br />of Project: _New _Addn X Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />� � 5hower <br />I Kitchen sink & disposal <br />vvaterneater <br />Sink (service/bar/m <br />Backflow preventer <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 thai I have read and examined this application and know ihe same io be true and correct. All provisions of laws and ordinances governing ihis lype of work will be complied <br />with whether specified herein or not. The granting of a permii does not presume to give authorily to violate or cancel the provision of any other state or local law regulating consiruction <br />That I am authorized by fhe owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.20oA WAC. <br />���: � '� ��?��� �7�2z�2c�oj� <br />Owner/Authorized Ag nt Sign�ure Date (Revised 4/2015) <br />`�Z <br />