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� PPLICATICJ� <br />t'ERMIT A <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT !'ERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: ��% �� /� „ nC� jsn � PROPERTYTAX# RMI� # �C I <br />r '/�/ d ��l u� i ��7 - <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />OWNER ` yl �/��� ^ ✓��j�5� �(�� Phone/E-mail `�� "' � � � ��t�.7 `� <br />Address ��;% �? �2�� City/5tate/Zip � GZ ��(� LL/� ��'%O � j <br />APPLICANT: L wner _ Owner's Agent _ Contractor _ Contractor'S Agef7t _ T0f18f11 (must provide a letter of conseN from the owner to dp work in the space) <br />CONTRACTOR <br />ress <br />BUI�DING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type: ,_ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler <br />Bus, Lic. # <br />HEAT SOURCE: <br />Othe <br />molition Chanqe of Use <br />DESCRIPTION OF WORK (additional space prov�ded on the back) . - <br />,������� G���s=�%� j�-s` ���� �'``�'�" �rf�r n��/ � �� <br />of Project: _New _Addn _Alteration v <br />Show Numbei (#) of fixtures <br />A/C – air handling units <br />Forced air systems <br />Water heater — <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriaeration <br />TI <br />� <br />�����C� Type of Project: _New _Addn _,Alteration �Repair <br />Show Number (#) of fixtures <br />1 Toilet <br />i uucting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Lavatory (wash basi <br />Shower <br />Kitchen sink & dispc <br />Dishwasher <br />vvater neatei <br />Sink (service <br />Backflow pre <br />Urinal <br />Drinking Fou <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 appiication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does nol presume io give authority to violate or cancel the provision of any olher state or local law regulating construction <br />That I am ayfFf r ed by the 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 296200A WAC. <br />i <br />Ow r ut Ag t S" na ure Date (Revised 4/2015) <br />�/ / <br />