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PERMIT APPLICATI�f� <br />BUILDIIVG/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 vwvw.everettwa.org <br />SITE ADDRESS: <br />�;� � i ��� ���,� �� < i� <br />LEGAL for new construction: Short <br />PROPERTY TAX # PERMIT # <br />�;'7 � "�—`�c�� I °l�0 �,�24c�C G� ��i,2= <br />JL� C��t�� �= Lot No. (attach copy of long legal description) <br />OWNER �,�� - � � �I o 2THe2E -A-55 0 1--1-C_. Phone/E-mail �� iv a ,�p,� , ,�� � �� <br />Address G ��-7� �,�4c�t �'l�:�r�. �d�/f.� ,�� �G-� City/State/Zip ��� ,�,.��'-,��5 � <br />APPLICANT: _ Owner ! Owner's Agent �C Contractor _ Contractor�S AJellt � TeflBflf (must provide a letler of consent from the owner lo dp work In the space) <br />CONTRACTOR .}— y�� �-j<' ��,� j�(Z�J\C�i State Lic. #�� F L�hRS 2.�o2L � City Bus. Lic. #(�1{O9"`2.Z <br />�2 <br />-�l <br />NC�r2TE-f�°2��{< o�PA2TlLt�n1TS <br />BUILDING PERMIT APPLICATION <br />Q�j�IPhone/Email Z� <br />��� � r� <br />� 2�3—�� <br />f PRICE OF WORK <br />Existing Use of Building ��l-"C l- FP.✓v� � �.-y HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric_ Other_ <br />Building type: ,_ Single Family _ Duplex _Townhouse 9� Multi-Family , Commercial <br />Type of project: New Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkfer _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />B FB57",�-� c..l t�� � e4-� r,-�•�'r�d.� Cc ��PvS�� T. vs�0(rQ5!'�'ftr-�'�.5� t�rnlGL�S �"F-��- <br />�i /d'� +�ii' 1,�'Ti.�lG � �l t� L � 2cTe,�� �.�k �F� �/G G'a �r�¢ P �£ i �ta' D rJ ,Sldrnl� L�� . <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 pipinq <br />�as tirepiac <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeratior <br />Woodstove <br />Ductinq <br />SPRINKLER / SUPPRESSION SYSTEM <br />i Number of Heads <br />pe of Project: _New _,Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />f Bathtub <br />Lavatorv (wash basin) <br />KliCilell SII1K LSc qlSpOsa <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/� <br />Backflow preventer (in: <br />Grease 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 irue and correct. All provisions of laws and ordinances governing this type of work will be compiied <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 periorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.ZOOA WAC. <br />'' D$" �S ! <br />wner/Authorized Agent Signature D te (Revised 4/2015) <br />� I� <br />