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it , <br />i�ERMIT APPLICATI��� <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />E ADDRESS: <br />�['l0 � ��� p''kv� �C� <br />3AL for new construction: Short PlaVsubdivis <br />ao��i �oo ��Z4�o � I�EIS��-022 <br />_Lot No. (attach copy of Ibng legal description) <br />�NER ��� -L� ( �(ofL'TNe2�� �55'0 �`_ Phone/E-mail �� iv c ,�� . W y�,-� <br />� <br />ress a E"�-7�' ���d �'d��=��tr� ��/f� .�� ��-� City/State/Zip �'.�' ,�.e���c.�s � C <br />'LICANT: Owner ! Owner's Agent � Contractor _ Contractor�5 A96(ll _ T8�8flf (must proviqe a letter of consent from the owner lo dp work in ihe space) <br />NTRACTOR '� �{�� �� State Lic. #�� S��2 L`� City Bus. Lic. #(� 1�O�-2 Z <br />ress'2�� �— � � � ��IG. .l Y�AI� ��J� l 7JO�?i Phone/Email Z�j% — �j '�j Z"�L�� '� `-i, <br />Nb�T�-F�`2E�FG s�P,<b2Tl�trcrGTS <br />BUILDING PERMIT APPLICATION <br />��� � �� �� <br />Phone/E-mail `Z� 7� - % �''( '� � � �� <br />CONTRACT PRICE OF WORK �� I tv �,�-� �"--- <br />Existing Use of Building ��i- i l- FAnn � Ly HEAT SOURCE: <br />Proposed Use of Building Gas_ Eiectric_ other <br />Building type: T Single Family _ Duplex _Townhouse 9� 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) : <br />/Rd�a''F`A'-�c�J c�F ,�,4�'e�„tAT�r.� �'c�gtPv��i�v,�4�,'�SP���-TJ.SFhrnlCLE.S �p"�r�- <br />�d/� �X15��C� ��C L� � L.���� C��F C'a�r�¢F'�Si��'Dr.! S'�dr��G� < <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handlinq units <br />vvater neater <br />Gas fireplace <br />Gas ranqe <br />eat pump <br />nit heater <br />Woodstove <br />Ducting <br />Other <br />KLER / SUPPRESSION SYSTEM <br />I Number of Heads <br />Type of Project: _New _,Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />i Toilet <br />Shower <br />Kitchen sink � <br />Dishwasher <br />Clothes wasF <br />Water heater <br />Sink (service� <br />Backflow pre� <br />Urinal <br />vrease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />h basin) <br />r <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 />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel ihe provision of any other state or local law regulating construction <br />That I am autho ' d by e o r f this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� OS �S ! <br />wner/Authorized Agent Signature D te (Revised �/2015) <br />%!� " <br />,� <br />