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f— �i`e`�!� f�.�����`.�P=i�l � <br />��S�,�I��/�I��f��a�0���/��,���1��/�I�I�/���9i���.��/��V���,�`���� <br />' CITY OF EVERETT P�RM1T' SIEI�VICES <br />3200 Cedar St., �verett, WA 982�1 425-257-$810 FAX 425-257-8857 vwvw•everettwa.org <br />TAX # <br />PERMIT # <br />� [� L[- <br />L�GAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal descrfption) <br />�► ' ji //'�%� �� Y�^�. <br />OWNER � �,Q ��L� - PhonelE-mail e �d� � �' <br />Addfess ! Z �Qv(/ City/State/Zip L,��� (� �J �� <br />APPLICANT: � Owner _ Owner's Agent ____ Contractor _ Contractor�s Age�t _ Terlant (must provida a leller of consent from lhe owner to dp work In ihe space) <br />p W nl eti— <br />BUILDING PERMIT APPLICATION <br />Lic. # <br />Phone/Email <br />Citv �us. Lic. # <br />ONTA�F� ��d��l/�✓L LUL �� O�>> <br />�/ �/ <br />ione/E-mail �/��2.2 �f . L yp ^� S�/'S/fQ0 '_ �i� <br />ONTRACT PRICE OF WORK _ ���� � � ' <br />Existing Use of Building �' GG HEAT SOURCE: <br />Proposed Use of Building d����' Gas p/Electric Qther <br />Building type; � Single Family _ Duplex _Townhouse _ Multi-Family ,�Commercial <br />Type of project: New _ Addition _ Remodel ,_ Repair=T.l. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additiona�l pace provided on the 6ack) : <br />��l.Sj�e7 i��: ��iS �'/�frr ��izr,2 `� , c�. 22�'�%� /-��o� ��v� e•��i �.�v�� -�il y�,e�/�-fi � <br />% v w�-,,l/ , � S:�.v-�S �f Z— f-E'i � lc:' Tc� . <br />-J-r'p :1.z-Q .. J { ��-l•C l /V��2 'G"� �U.lL/� /�`J .t�`� <br />Type of Project: _New _Addn _Alteration _Repair <br />5how Num4er (#) offixtures <br />A/C — air handling units <br />r <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />� Other <br />sPRi����� � su����ssao� ��s-��nn <br />Number of Heads <br />Project: _,New �Addn ,_,Alteration _Repair <br />Show Number (#) of fixfures <br />Toilet <br />�. Bathtub <br />`� l.avatory (wash basin). <br />`�� Sliower <br />�` � `� Kitchen sink & disposal <br />� 'e Dishwasher ' <br />lothes washer � <br />fer heater <br />' Sink ervice/bar/mop/etc,) <br />Backflo � preventer (inside bldg <br />llrinal � � - <br />Drinking Fou in <br />� Floor drain a <br />� Grease trap °�, <br />� Roqf drains �T <br />Medical Gas <br />Other: <br />�ther; <br />I hefeby certifythat I have read and examined this application and knowihe same fo be true and correct All provis(ons of laws and ordinances governing this lype of work will �comp <br />wiih whether specified herein of not. The graniing of a pefmlt does noi presume to give authority {o violate or cancel ihe pfoVision of any other state or local law regulating consiruciion <br />That I arn autho�ize y the owner of this pro to perform the wo�k for which application is made and I comply wi�h ihe Siate Contracto�s Law 1827 RCW and 296.200A WAC. <br />/I�-- �'- �� �� 1 <br />vd er/Authorized ent Signat re Date (Revised 4/2015) <br />( � <br />Z <br />