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�ERMIT APPLICATIO� <br />BUILQING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <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: <br />LEGAL for new construction: Short PlaUsubdivisi <br />OWNER <br />PROPERTY TAX # <br />'�'V �� '�C�' � �/ `: � i ��l i � <br />PERMIT #,. <br />No. (attach copy of Ibng legal description) <br />Phone/E-mail •u`���� �� •� <br />Iress j, G'j L`'� ���7J'f�� h� ICity/State/Zip (�/,;e✓�Olv� �/Z G�,y ��/!i ��-�— <br />�rc <br />PLICANT: _ �wner _ Owner's Agent �Contractor _ Contractor'S A je�f _ T2flaflf (musl provide a leqer of consent from the owner lo dp work In the space) <br />CONTRACTURl� <br />a <br />BUILDING PERMIT APPLICATION <br />�' IState Lic. # � � <br />� y�� �� I Phone/Email �� D <br />�ONTACS FOR PER IT <br />�j�-�, � G� � � �<< r��� <br />'hone/E-mail 3� (r� 7 % � <br />�ONTRACT PRICE OF WOR � <br />City Bus. Lic. # � in j <br />�c�J � > ��� <br />;Z Z <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric� Other_ <br />Building type: �gle Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition �/FZ'emodel Repair T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) :. j--� �✓ �l�r �� ����?— G,.., /� ��= �-S/ <br />C �} G r : � c �S � �,' X fti rrs � ��C� <�,�5 � �j�, rn / o� ✓� �:(� i' � � q , 'i— c�l � �yrrrt cr,r � � . <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air svstems <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />j c�oiier <br />� Refrigeration <br />; Woodstove <br />� Ducting <br />I Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />I Number of Heads <br />Type of Project: _New _Addn _Alteration �pair <br />Show Number (#) of fixtures <br />�avatory �wasn aasin� <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer (in� <br />urinKing rou <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 type of work will be complied <br />with whether specifed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized 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 296.200A WAC. <br />D�'-�� t✓` � /i 5'�r � <br />OwnerlA thorized Agent Signature e (Revised 4/2015) <br />, y 7i <br />