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� <br />��RI�II� Q�r�pCAT'� <br />BUILDING/MECH�►NICAL/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 />ITE ADDRESS: <br />7�� I(�'�?�'l�i Sc #/-�-� <br />EGAL for new construction: Short PlaUsubdivision <br />OWNER <br />Haaress � <br />APPLICANT: Owner _ Owner's Agent _ Contractor <br />CONTRACTOR <br />Address <br />L 5 k� iZ.�1�/,: iv i.� j, �.1 C� . <br />� V � � 1 1 � �� <br />BUILDING P RMIT APPLICATION <br />TAX # I PERMIT� <br />t� I ��L� <br />No. (attach copy of long legal description) <br />Phone/E-mail �$ `� LS - � tj � ~ �- <br />City/State/Zip �' = � — <br />Contractor's Agent 2f18f1t (must provide a leqer of consent from the owner lo dp work in the space) <br />State Lic. # <br />PhonelEmail <br />ione/E-mail ��1�'�� Jrx,� <br />ONTRACT PRICE OF WORK <br />Existing Use of Building �,' �i �1 t'1-��[�/1V'�� �� <br />Proposed Use of Building _� `1L � <br />Building type: ^ Single Family _ Duplex _Townhouse _ Multi-Family �Commercial <br />Type of project: New �ddition Remodel Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back): <br />il��cf �v�c��l 5����� �.�� Ai� <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />A/C – air handling units <br />Forced air systems <br />e <br />�as nrepiace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Woodstove <br />Ductinq <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />City Bus. Lic. # <br />����� 3 <br />HEAT SOURCE; <br />_ Electric_ Other <br />olition_Change of Use <br />MIT APPLICATIO <br />of Project: _New ✓Addn ,_,Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />Kitchen sink & disposal <br />Dishwasher <br />r <br />tsacKriow preventf <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 ihis 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 />wilhlwhether specified herein or not. The granting of a permit does not presume to give authority io violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by ihe owner of this property to perform the work for which applicatio is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />1 I �' '� G�1 � J <br />'� ��1 �'l �' <br />Owner AutfSoriz d Agent Signature Da e (Revised 4/2015) <br />,� ;� <br />i <br />