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��' �.:�T ��' f�Lf��,T� °� <br />��B�.�I��/N�����I�I�,��/P�.G��II�II��/�1��1���9�6��.��/��V���,9`���� <br />� Cl�f`l( �F C�I�Fi�`�T V��F�fUll`I ��R�11��c:� <br />3200-Cedar St., �verett, WA �8201 425-257-881 D FAX 425-257-8857 www.everettwa.�o�g <br />for new construction: Short <br />pROPERTY T�4X # PE MIT # <br />� �,�;G-� � l � v �- D � <br />vision Lot No. (attach �opy of long legal descriptinn) <br />OWNER ���1+ 5 �`.�-,Cr+i� � ' Phone/E-mail <br />1 �. �/1 � � � <br />Add�ess � f L;e�C Gity/State2ip �-�a/-�—�'� l.� 4"� ����" <br />APPLICANT:��Owner _ Owner's Agent _ ontractor _ Contractor's Agent _ Tenant (must provtde a lener ot �ansBni rrom u,e owner lo dP worx In ihe space� <br />� <br />BUII.DING PER�IAIT APPLICATIOM <br />���. # � �� -��� - a <br />��---,�__:, � <br />CONTRACT PRICE �F WORK <br />S c�c� �us. ���. # D�3��i <br />�,�� -��i� -SSr � <br />IFxisting Use of Building � HEAT SOURCE; � <br />Proposed Use of Building �as Electric �ther <br />Buildmq type: ^ Single Family _ Duplex _Townh�use _ Muiti-Family ,_ Commercial <br />i y;�., �� ;�iuj c:: -- � ", ,���r'di`Inil � _!t�n�i I --- -_R�nair_ "1- l. Sign _ Sprinkler -- I�emoliuon_._—C%hange nf Use __ _ <br />DESCRIPTION OF WORK (additional space providedqn fhe 6ack): - �^ � S. ..�s,,�. �v� �Y'�--.-�T <br />.���.��� �c�:�--�-� �� �� t �� � � � <br />� �\n,a.`lJ v • \ y J <br />�-J_+- -o J <br />of Project: _New _Addn _Alteratinn _Repair <br />ShowNumber(#) offixfures <br />A/C - air handling units <br />-�- Forced air systems _ <br />SPRIId�fLER / SUPPRlESS10R1 SXSTEM <br />Number of Heads <br />of Proje�t: ^New _Addn ,_,Alteratinn _.Repair <br />ShoYv Number (#) of fixfures <br />Kitchen sink 8� disposal <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/badmop/et <br />Backfloriv preventer (ii�,si� <br />llrinal � - <br />Drinking Fountain <br />Floor drain • <br />Grease trap <br />Raaf drains � � <br />Medical Gas <br />Other: <br />Other: <br />I hereby certifythai I have fead and examined ihfs application and know 1he same io be true and correct All provislo�s of laws and ordinances governing ihis lype of work will be complied <br />wilh whelher specified herein of not, The graniing of a permit does noi presume io give authority to vlolate or cancel ihe provision of any other state or local laW regulating consiruction <br />That I am autho 'zed by 1he owner of ihis property to perform the Wofk forwh7ch application is made and I comply with the Siate Contractofs Law 1827 RCW and 296,2DoA WAC. <br />/��-- ��_ a�`'/ s <br />O ner/Authorized Ayent Signature Date (Rev(sed 4/2015) <br />