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0 <br />�� <br />. • <br />�GRIWI'T /`1f �L��s!'"'►T'VIY <br />BUILDING/IVIE�HAiVICAL/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 />ADDRESS� <br />LEGAL for new construction: ShoR PlaUsubdivision <br />OWNER ��d� c�/�1�12j '�- <br />ress S� �X � <br />'LICANT: Owner <br />CONTRACTOR <br />Address '�p�ef <br />Agent <br />BUILDING PERMIT APPLICATION <br />TAX # <br />l�i�f � '�' 7c�'` <br />No. (attach copy of Ibng legal description) <br />Phone/E-mail L� Z—J�—�j�3 <br />ICity/State/Zip �-1/� �� QR"�() ?� <br />r _ <br />_ Contractor�5 A9Bf7t _ TBflBfll (must provide a let�er of consenl irom the owne� lo dp work in �he space) <br />�f- � . State �ic. #D��.�(�l-f q��-I City Bus, Lic. <br />'�%, ��- ��.�? Phone/Email �ZS—�J��p�lv <br />CONTACT FOR PERMIT ��� 2��,�� <br />Phone/E-mail Z�/����Cp �p <br />CONTRACT PRICE OF WORK �(%/ �� �� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas � Electric� Other_ <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):=����LL � N��� ��� �u��i _ <br />F%T- ��p � y5��. <br />ICAL PE <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air svstems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />n <br />Unit heater <br />Boiler <br />Refriqeration <br />i uucting <br />! Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _,Alteration _Repair <br />Show Number (#) of fixtures <br />1 Toilet <br />ower <br />chen sink & dispo <br />Clothes washer <br />Water heater <br />Sink (service/bar/r <br />Backflow prevente <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />n <br />I hereby certify that I have read and examined this application and know the same to be irue 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 the provision of any oiher state or local law regulating construction <br />hat I am authorized by the owner of this property to o work for which a plication is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />�-�� „ `����:�� �0�-/23O/ � <br />(Revised 4/2015) <br />