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PE li A�PLIC�TIO <br />�111LDIN(�/MEC�IANfGAL/PLl11VI�IIVG/SI�iV/S��ItV�CL�R/C�EIVIOLI�"10� <br />CtTY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WR 98201 425-257-8$10 FAX 425-257-8857 www.everettwa.org <br />ITE ADDRESS: ��,/ ,, PROPERTY TAX tJ `�yll� � /� <br />f: i�� �u1k � �f� VV . 1..!'� `, ,'` ��; f � ���bi <br />LEGAL for new conslruciion: Short PlaUsubdiv:sion <br />OWNER � �� �, , � �,��,; t <br />Address : `�ta_' �v� � � , � + <br />APPLICANT: � Owner _ Owner's Agent Contractor <br />CONTRACTORi.� �,��=t'r���<':�,� `` ` <br />Address "� `y. , <br />TENANT BUSINESS NAME <br />� <br />{1'_i�� i =� ' <br />BUIL�ING+ PERMI`T APPLIC�Ti�� <br />L.o( No. (attach ccpy of long legal description) <br />Phone/E-mail r '• �, ` ° ,; <br />� �� CityiState/Z�p , <br />_ ConlBCtor 5 Ager1C ��`1 Tgnanf (must prov�de a lener of conser:t t-om tne owner io do work in the� space) <br />State Lic. # City Bus. Lic. tt , z%�� . <br />Phono,Emeil . „_ _ <br />���� <br />CONTACT FOR PERMIT <br />Phone/E-mail �/'i', � <br />COPdTRAC7 PRICE OF WORK � ��A � _ `� ( i ����_I _ <br />Existing Use of Buildiny � <br />Proposed Use of Buildinc� t�,�- r _ � � <br />Building type: _.__,,, Single Family ___.__. Dupiex _7ownhouse ,...,,..__ Multi-Family _<_ Commercial <br />Type of project_ New Addition Rernodel Repair T.L s: Siqn S rip nkler <br />DESGRIPTION OF WORK (additionar space ��rov�ded on the back) : <br />Fi��r sour�cE <br />Gas �� Electric Other <br />molition Chanae of Use <br />� , � . , ., . . <br />?. �� `.t��. � . . tt_ .�, �.�z tr,.. �i � �-., , j_ � ,��{ - ' <br />j � € <br />3< ..�i , i r . 't e—... . i . . —� .. � 3 �. < � <br />Type of Project: _New �Addn __Alteration _Repair <br />Show Number (#) af fixtures <br />A/C — air handling units <br />Forced air svstems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pumP <br />Unil heater <br />Boiler <br />Refrigeration <br />. Woodstove <br />Ductin� <br />Other <br />�,�9� / St9PE�F��55iAPJ �Y�T�h� <br />I Number of Heads <br />k. '�' � <br />Type of Project: ,New �_Addn ._,....._Alteration Repair <br />Show Number (7) of fixtures <br />Toilet <br />j 8athtub <br />Lavatory (wash basin) <br />� Shower <br />� Kitchen sink & disposal <br />I Dishwasher <br />I Clothes washer <br />! Water heater <br />' Sink (service/bar/mop/etc.} <br />� <br />Backflow preventer <br />Urinal <br />� Drinkin Fountain <br />Floor drain <br />I Grease trap <br />I Roof drains <br />' tvledical Gas � <br />j Other: <br />I <br />I Qther. <br />I hereby certify fhai I have read and exarnined this applicaticn and know the same to be Irue and correcL Ali provisions of laws antl ord�nances governing this rype o( work wiil be coittp'�. <br />with whether speciGed herein or not The granting ot a permit does not presume lo give authority to viotate or cancel the provision o( any other state or local Vaw regulaiing construction <br />7hat I am aulhorized by lhe owner af this property to perir�nn lne work for whlr_h appl�cat�on is matle and I compty with the Siate GoNraclnrs I_2w 18.27 RCW and 236.200A WAC. <br />OwnerlAutharized Agent Signature Date (Revi,ed 9�7014) <br />�lz <br />