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l��[�.��`1� � I�l�aa� �; lf ���� <br />C��������/B�i1��I����d��a�/��,�k�d�IG��/�1��9/�f�G�B�9��.L I�/[��G�Da6�'��I� <br />�� CiTY C�� E!/ERETI' P�i�f�ill IT SERVICE� <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-�857 www.everettwa,org <br />� 'y� Va,nS��r���i�fui�S {o� �lsl0-G <br />�ADDRE55• <br />,7.; l Z �i �l.'1-�,l.i�'.'.} �.��5�" <br />9AL for new constr4�ction: Short lat/subdivision_ <br />OWNER <br />TAX # <br />PERMI7' # <br />No, (attach copy of Ibng legal descriptiDn) <br />PhonelE-mail �� (.v. �5 ia ' � W <br />dress Ci � i�l`�Y1'�,/1 ' � �.ti�,� �city/State/zip � t. �.f'j- �' G'v 7 <br />�PLICANT: Owner _ Owner's Agent _, Contractor _ Contracior�s Age�t _ Tellaflt {mus( proyida a le�ler of cpnsenl from l�e owner io dp worh In ihe space) <br />� �'vw� <br />�i C.�1'VL/�'►L 1(�iG ``l�l�� <br />BUI�DING PERMIT APPLICATIOM <br />Existing Use of Bullding <br />LIC, # <br />l��- Phone/Email <br />�one/E-mail <br />ONTRACT PRICE OF WO <br />Proposed Use of Building S" .�2'" � �as_ <br />Building type; � ingle Family _ Duplex Townhouse ___, Multi-Family ____ Commercial <br />Type of project New Addition Remodel Repait T.I. Sign Sprinkler _,Der <br />DESCRIPTION OF WORK (additional space provided o=t n�k� ��� ����� �� <br />��?�a"a- ,:�,°L�ci1� [�> L`�.�t- �A-�-- _ _ <br />Cl,e,,(L%�12 ��� ;i1� K:�c-c.,fi"�� Yl �;t-, ,�'i:,,iL,u,.l, �,:Y^�-' ��► '�'�+-�'�'�. <br />�'✓(ZL.(i r <br />R��� tc ���y �"� , 1-� �v�L.� <br />� ��1Ct;A,1 �, �.,�fl- � — i2Lt-h��S�— <br />a ..������-r nonl 1rAT1AN PLUMBING PEF <br />Type of Project: _New _Addn _Alteration _Repair <br />5how Num6er (#) of fixfures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />[3oiler <br />Refri4eration <br />� (�thef <br />SPRIPdI{�C�.i�� / ��0'��I���fl��9 <br />Number of Heads <br />�US, �..IC. # <br />� <br />HEAT SOURCE: <br />�lition_Change of Use <br />�2-G�C �, bc� <br />�,�Cq,;lti, �-�.l J ►l� �rl �.E��i <br />of Project: _.New _Addn �,Alteration _.Repair <br />Sho4v Number (#) of fxfures <br />Kitchen sink & disposal <br />Dishwasher ' <br />Clothes washer <br />Wafer heater <br />Sink (service/bar/mop/et <br />Backflow preventer (insi� <br />Urinal � - <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains � <br />Medical Gas <br />Other: <br />�ther: <br />� herepy cerfify that I have read and examined this appllcation and know ihe same fo be true and cor�ect AU provisions of laws and ordinances governing ihis type of work will be complied <br />wllh whefher specified herein or not. The granting of a permit does noi presume to give authority io �iolate or cancel ihe provision of any other siaie or local law regulaiing constnaetion <br />That I am auihorized by ihe owner of this properry to perform the work forwhich application is made and 1 comply with ihe Siate Coniractors Law 18.27 RCW and 296.20oA WAC. <br /><<��1� ' <br />' Date (FZevised 4/2�95) <br />ner! iorized Agent Signature <br />