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� ���� <br />����i�������� <br />�lJi��IIVG/I1�E�HANICA�C/PL.�J,JV1_�IG�1/SPRIt�I�CLER/DEtVIOL,ITI�IV <br />CITY OF EVERETT P�RIVIIi SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ADDRESS: <br />C7� � .S� � ���'C7% " <br />TAX tJ <br />L�GAL for new construction: Short Plat/subdivision Lot No. <br />� pFRMIT # <br />�) u c' aiJ l./ �,�---� <br />(attach copy of Ibng legal description) <br />OWNER ��J/NS�� ��"���n`�� PhonelE-mail �s--3s-3 .�5� /��C c�-��� <br />Address;7U() s� Cl����� �,�� � ��%�%� City/State/Zip �i�L-���' [-�—/� rl:�'���rf <br />APPLICANT: Owner _ Owner's Agent _ Contractor _ Contractor's Agent �PTefla�t (must p�ovide a letter of consenl from the owne� lo dp work In Ihe space) <br />� <br />UIL <br />^� ��,... ..� <br />� � � � LIi■� 1(i�'�r <br />I <br />SUJIIVCJJ IVHIYIC /�j <br />. .. ; C. ��: /T ��� �1 ,�� r :. I� �� C <br />%j � ti. C t: t� fk <br />NG PERMIT APPLICATION <br />Phone/Email ( l�-Z� <br />Phone/E-mail � <br />CONTRACT PRICE OF WORK <br />City Bus, t;ic. # <br />��� ` ���� <br />y ;� -5 1 � G��*�i; � <br />Existing Use of Building St•fut'P�� �-�=�--�'z� 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 j� T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back):, <br />I-� G 0 Vl,ti, ' _;�� U Y'Y'0 G,�� v'�, �� V�til �� r 1�-- ��`� \ t"�('ti C�G� Cl ��n ��� �'� CC S-%�,�„-� C p(� 1'�QrG� � <br />-�. �1�Y�, SIY��S �'I/LGI� Gt�. U� � `��r Wc:�Sh �= %�-�lr U� <br />ofProject: _New_Addn _Alteration_Repair <br />5how Number (#) of fixfures <br />A/C — air handling units <br />--T Forced air svstems <br />r heater <br />ireplace <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeration <br />� Other_ <br />SPRIR9KL.ER / SUPP <br />Number of Heads <br />ION SYSTEM <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & dis.-osal <br />Dishwasher , <br />Clothes washer <br />Water he�ter <br />Sink (s�rvice/bar/mop/etc.) <br />'�aclfflow preventer (inside b <br />Roof dra <br />Medical <br />Other: <br />Other: <br />I hereby certify that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />wiih whether specified herein or not. The granting of a permit does not presume lo give authority to violate or cancel the provision of any other staie or local laW regulating construclion <br />That I am authorized by the owner of this property io perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />, , :�r , �,> ,1�_ �f� .� : G �/_� � /i 5 <br />ner/ uthonzed Age2 ignat e Date (Revised 4/2015) <br />