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. . <br />�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 />O L ",a� �'7 c�1/ � � � <br />for new construction: Short PIaUs� <br />Z`���J# I l�O �7�Z�C I PE l� 5�� <br />Lot No. (attach copy of Ibng legal description) <br />OWNER ��� -L� d�I o/LTr9e2� �A-55o t-1-C_. Phone/E-mail �� r,�:� �� - ��,�,+� <br />e <br />Address a � �� � S;�s� �'s�,� r� ��/� �� ��� City/State/Zip �s' ,�-„s�,�c.�s � <br />APPLICANT: Owner _ Owner's Agent � Contractor _ Contractor�5 A9811I _ T8l12l1f (must provida a letter of conseN from the ownef to dp work in ihe space) <br />CONTRACTOR � ' �����' � � State Lic. # �j '� S �1p2 L � City Bus, Lic. # C� 1 �O�`Z � <br />Address 2�� ��`i- !�i y`-=� �-k�IG � ��� V�ld� 1 UQ�Z PhonelEmail ZGj i) - g'rj Z•��t� �'� `'� <br />N(� r2TH+ c° 2� �f< ,�$ PA 2�l� C�!'�S <br />BUILDING PERMIT APPLICATION <br />ne/E-mail ��7j- %�j "r�- (�j �% <br />r <br />NTRACT PRICE OF WORK � 1 Ci ��� 7%` ��--- <br />Existing Use of Building ��l- a t- FP� nn � t�� 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) : <br />/ AB�'P`,�-� c..! �F-� �,4� �,•r.4T�r.� �c �'OYPvS'i � �rP �fr`SPr�'�-T'�.S iFsnlCL�S �"�r� <br />` s/d � �X�S��� >c.+�Il� L� �� �l��-�, �� C'arrettP��i�r�Dr+! S�enl�L� . <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />A/C - air handling units <br />Forced air svstems <br />PRI <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />' SUPPRESSION SYSTEM <br />Number of Heads <br />of Project: _,New �Addn _Alteration ,_Repair <br />Show Number (#) of fixtures <br />i Toilet <br />� <br />Shower <br />Kitchen sink 8� disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer (ins <br />Urinal <br />�rease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this 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 />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am autho ' d by e o r f this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />- � "'' OS �S ! <br />wner/Authorized Agent Signature D te (Revised 4/2015) <br />\I <br />