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� � ��0� ����Q����� <br />� <br />I��I��IR��/���C�������/P�,��I�1R��/�l�l�/���������/��G��aE`���G� <br />' CITY OF EVEREiT P�RMIi SERVICES <br />3200 Cedar St., �verett, WA 982�1 425-257-8810 FAX 425-257-8857 www.everettwa.Qrg <br />� - ` �'�, <br />SITE ADDRESS: ° f �- PROPERTYTAX # PERMiT #,_ � � � �,' <br />�� �: -r.�y �,,�.� . � <br />L�GAL for new construction, Short PlaUsubdivision Lot No, (attach copy of long legal description) <br />r i- <br />OWNER l�,� �,.�.�.._ Phone/E-mail �1�^— � 7 Z" �"/ <br />Addfess Lf-v o v� cL City/State/Zip �i✓�v%.st"j� l:"� � � yK'' � <br />�APPLICANT: _ Owner _ Ow�er's Agent �Contfactor c�, Contfactor's Age�t _ Tenant (musl provida a Ietler of consent from the owner to dp work In the space) <br />CONTRACTOR j�j1%G2'i �-� �7i State Lic, # L'� i r�'7 c;. i �`i 7L �- .l City Sus, L.ic. #� �li� <br />� `y' ' �� �'��' Phone/Email .2- �'J 6 '' <br />Address ( �f� �fV'i C ( �r� �-� �/JCILV�����' .Lv'/+ j�' � r-7 ��- <br />CONTACT FQR PERMIT � <br />�y <br />��� l�� Y'E."'C .�Y"�' Phone/E-mail ��`Lt � t� 5 �� �;. r�w `' 7E<�S , L�.�'>'v`. <br />BUILDING PERMIT APPLICATION coNTr�cT PRICE oF woRK cs��. — <br />Existing Use of Building � HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric <br />Building type: ^ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair =: T.I. _ Sign _Sprinkler_Demolition_ChangE <br />AESCRIPTION OF WORK (addifional space provided on the back): <br />�' �� ;'� ���� � rz Y� ` f u t�"" <br />��z � ���. r � �1^- <br />U � <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />of Use <br />PLUMBING PERMIT APPLICATI <br />of Project: ^New _Addn ,_,Alteration _.Repair <br />Show Number (#) of fxfures <br />I Toilet <br />vasher <br />es was <br />� Heat pump Backflow prevente� (inside blqg) <br />Unit heater Urinal - <br />� Boiler Drinking Fountain <br />Refrigeration Floor drain _ <br />Woodstove Grease trap <br />J Ducting � Ro4f drains <br />� Other Medical Gas <br />SPRI@+11�I ER / SIJPPQZESS90Bd ���°���Ii Other: <br />� Number of Heads Other: <br />� hefepy cerfify that I have read and examined ihis appllcation and know ihe same 10 be true and correct All provisfons of laws and ordinances governing ihis lype of work will be complied <br />wiih whether specified herein or not. The granting of a permit does not presume to give authority {o violate or cancel ihe provision of any other staie or local law regulating conslruction <br />That I am authorized by the owr�this pro e� to�erform the work forwhich application is made and I comply with ihe Siate Contractors Law 1827 RCW and 296.200A WAC. <br />-� �� �f ��%�� f� � � � r�`". <br />- .- _• ---, ^---.�.___..._,. i ate (Revise�4/2015) <br />