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[��I�N��`� ; �f�aQ�/� 1( [ � <br />L��I��IR��/���I��N�O���/��,���IR��/�I�I�/���86�����/��G���,��'��I� <br />' CITY OF EVERETT P�RM1T' SERVICES <br />3200 Cedar St., �verett, WA 98201 A�25-257-$810 FAX 425-257-8857 www.everettwa.org <br />:ADDRE55: <br />Sij_ C' �,f�A /L �% �u <br />AL for new construction: Short Plat/suhdivisi <br />OWNER r�� c2 h-� A/v%i ���J +rl; <br />Address �, (J, ' C %� ; C � <br />APPLICANT: Owner _ Owner's Agent _ <br />CONTRACTOR �� f�..i ,r��.'sZ �-' <br />i <br />G <br />Cont�actor <br />PROPERNTAX # PERMIT # <br />�� �� C� s�. C� CS C� tfCi �i.�C� C� �� � i� I�� '� �,�i <br />Lot No, (attach copy of long legal description) <br />=� Phone/E-mail � Y.Z� �" �� � / <br />� <br />City/statelzip �L'l`/� � %% �--� %=S�t-`� <br />Contractor�s A9e�t ___, Tellaflf (must provida a leller of co�senl Vom the owner to dp work In Ihe space) <br />Lic, # <br />Phone/Email <br />Bus. L.ic. # <br />BU1I.DING PERMIT APPLICATIOM coNT�cT PRICE oF woRK � � �C �'J`� <br />Existing Use �f Building _: �•� [.� �� � �� HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric ' �ther <br />Building type: �. Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New _ Addition ,_ Remodel �. Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): /�` f� L; ��� �`` f�� �j � �- � c'ciL� <br />r� i <br />%/-� � C_`� I`„J r C :_ / il. %c :., S' :� . l� � /�c �.; h7/� �/c�'r9 i•n� ,T L.Vi� �'f -z ,�-S il.' ;� ;�i�.:/� K z /%�rJ � : K <br />. � � f <br />� rl I <br />r:=�/� k � , ���1 %�i S'��✓/� • J'J¢ix; �/-��� � %<c�/� � ; .,��-, ��� %�c �.: ;�:1, j L..:> ,., Crr1/T�J�-� � � � U;.��.;, <br />A \l <br />ofProject: _New_Addn _Alteration,� <br />�- ShowNumber(#) offiixtures <br />A/C — air handling units <br />as <br />Exhau <br />Heat � <br />eration <br />� Type of Project: ^New_Addn �,Alteration.lS.Repair <br />Show Number (#) of �xtures <br />I Toilet _ <br />n sink �pesaJ <br />�sher � <br />s Washef <br />heater <br />;ervicelbadmop/etc.; <br />�w preventer (inside <br />iq Fountain <br />Woodstove t�rease trap <br />� Ducting � Raof drains <br />I Other Medical Gas <br />SPRIP��L.ER / S�JI'PQZ�SS901t9 �liS'fEM Other. . . <br />Number of Heads Other <br />I herepy certify ihat I have read and examined ihis application and know ihe same to be true and correct All provis(ons of laws and ordinances governing this lype of work will be complied <br />wilh whether specified herein or not. The granting of a permit does noi presume to give autho�ty io violate or cancel ihe provision of any other state or local law regulaiing conslruction <br />That I am auihorized by the owner of ihis property to perform the work torwhich application is made and I comply with the State Contractors Law 1827 RCW and 296.20oA WAC. <br />^ ` ----- - `i + ' <br />� -- ci��� �� /o- f� , ��,��. <br />.�—= <br />Owner/Authorized Agent Signature Date (Revised 4/2�15) <br />