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i'ERiViIT APPLICATION <br />BUILDIIVG/iVIECHANICAL/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: PROPERTY TAX # PERMI' # <br />�,;� �=�� �'.�<�I �% '� �I �� � � i��1.� _ � � _ (:� I C..� <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />OWNER G���Zi <br />Phone/E-mail �l> ,;'� � � <br />Address j ','�x� ���;'f^��� `,��!={%_� jr ICity/State/Zip <br />APPLICANT: Owner � Owner's Agent _ Contractor _ Contractor�5 AgB�t _ T2flBfll (must provide a letter of conseN from the owner la dp work In the space) <br />CONTRACTUR �;� <br />Address �;�J�' /,, <br />—i4„ <br />�- °-�,� � , <br />�� � ,��,LYa/ j ; ji`�---,�, �State Lic. # <br />BUILDING PERMIT APPLICATION <br />Phone/Email <br />,ifl� l� L.�3/'��_ <br />Phone/E-mail '•'' �_:�,;i <br />CONTRACT PRICE OF WORK <br />`.,� � <br />Existing Use of Building ._��c�.���� :� C�i �%�)l'�_ : <br />� �� % �z ;� //�"f�! /� <br />Proposed Use of Building �� Li2� l�� •_- —� %�C. � <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />-��1 / r=�;`�`i — �(/l�l ��/c:�C/ Y�'�`vl1v�}� �'i�T ��; �)C �;1� <br />� <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas pipina <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeration <br />i uucung <br />� Other <br />RINKLER / SUPPRESSION <br />Number of Heads <br />TEM <br />City Bus. Lic. # <br />�'"k� (�' �'(.4,'Y�'�G!>G� ,� � � �; <br />� <br />�� � �'� j , ,�''--�-�,`'' <br />�% <br />�,,<>r,f����,:_ , ��✓ <br />HEAT SOURCE: <br />Electric� Other. <br />on Change of Use <br />Type of Project: _New _Addn _,Alteration ,_Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />( Shower <br />I Kitchen sink & disposal <br />Clothes washer <br />Water heater <br />Sink (service/b� <br />�cKrlow pre <br />'inal <br />�inking Fou <br />oor drain <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify ihat I have read and examined this application and know ihe same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />wilh whether specified herein or not. The granting of a permit does not presume io give authority to violate or cancel ihe provision of any other state or local law regulating construction <br />That I a� ed the oy,�ne t�s-prqperty ib perform the work for which application is made and I comply wilh the State Contractors Law 18.27 RCW and 296.200A WAC. <br />`�� l . . j ,, <br />i � <br />� �// � _ � � l �� �j � r��,%i�'. <br />Owner/Authon "ed Agent Sig�ature Date (Revised 4/2015) <br />�'2 <br />