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����'d0`� �,�PC�'— l�Q���11 ��� <br />��I�.�IN�/����l��p��l�/PL���li��l�l��I/��Ra�����/��V�l��,l`�p�� <br />' CITY OF EVERETT P�R�iIIT SERVICES <br />3200 Cedar St., �verett, WA �8201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />for new construction: 5hort <br />PROPERN TAX #t PERMIT # <br />����� <br />"� �p Lot No,� (attach copy of Ibng legal description) <br />OWNER �� / PhonelE-mail <br />Address <br />� ,.- City/State/Zip � o-�C� <br />APPLICANT: Owner _ Owner's Agent Contractor _ Contractor's Agent _ Tenant (must provide a leuer or �onseni trom me owner to ap woric In me space) <br />f+l1hITOA/+TAO �i/I/f'/// � /A/���Ja is� State Lic, # ( ��/(J�/ 'W ,// / 7� J G_C'I� SUS. �IC. # � G�(,� <br />Phone/Email <br />BUILDING PERMIT APPLICATION coNTRacT PRICE oF WORK <br />Existing Use �f Building <br />Proposed Use of Building !"E— ���✓%���5-1 �f �� 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 provlded on the back): <br />G'�i��%�r.��7�r✓ � �/',�'�/ �'�i�,�' <br />Type of Project: �ew _Addn _Alteration _Repair <br />how Num6er (#) of fixtures <br />A/C — air handling units <br />—�— Forced air systems <br />r heater <br />Range ho <br />Exhaust f� <br />Heat pum <br />Unit heate <br />� <br />HF,,AT SOURCE; <br />on ChanQe of Use <br />of Project: New _Addn ____Alteration _Repair <br />how Number (#) of fixfures <br />.� � Toilet � <br />Kitchen sink & disp <br />Dishwasher ' <br />Clothes washer <br />Sink (service/barlm <br />Backflow preventef <br />Urinal <br />Drinking Fountairt <br />Floor drain <br />� Ducting � naar arains <br />� Other Medical Gas <br />SPRIIdaCILER / SUPPRESSIOPd �I�:STEM Other: <br />Number of Heads Other: <br />I hereby cerfify ihat I hav d and examined ihis application and know the same io be irue and correct. All provislons of laws and ordinances governing ihis lype of work will be complied <br />wiih whelher s ec e i ot, granting of a permii does not presume lo give authority io violate or cancel ihe provision of any other siate or local laW regulating construcllon <br />P � <br />That I am aui y this property io perform ihe work for which application is made and I comply with the State Contractors Law 18.27 RGW and 296.2DoA WAC. <br />Agent Signature <br />(Revised 4/2095) <br />