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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 />ADDRESS: <br />t� n 1 °� � s� <br />for new construction: Short <br />�� �PRZ`�O�J#� t�� �J�Z�D I �`M�� J-OZ <br />PlaUsubdivision 6�-�� /� _Lot No. (attach copy of Ibng legal description) <br />WNER ��� —�( /��o(LTI-9e2� �-t-5S0 �`_ Phone/E-mail �� ra.i C,� ,�e ���,'�� <br />idress p � '� � � �-�i„q �( ���L�c.� i � � 'LY/[� .�� �G � City/State/Zip �'j`S' ,���,�, �5 �. <br />PPUCANT: Owner _ Owner's Agent �C COf1lf8CtOf _ COIltf8CY0f�S A92f1I _ T2118f1t (must provide a letter of conseN from the owner to dp work in the space) <br />ONTRACTOR � ���' �L� State Lic. #�� S 21�2L � City Bus. Lic. #(�Iloq-'ZZ <br />idress'��� ��- � �, �'=-` ��� � ��� �A � �Q3� Phone/Email Z-1j7� - g �"J Z"�L�� � � <br />N C� r27�'+ <` 2� �f< r� PR 2TlLt rcr�l T S <br />BUILDING PERMIT APPLICATION <br />Fq PERMIT <br />��� � �� � <br />i 2� _ � �' <br />� PRICE OF WORK <br />Existing Use of Building �lA.t-"� l- FEe nn i L� 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 (additionai space provrded on the back) : <br />jkA�'P`.��-� csJ t�r� ��I,•r.?T�r.� �.�tPvS�� � vr�4�v�SP�'fit�',�"h��nlGL�S �"�r�- <br />` L¢'� �X1S��C� ��L� L�. f�srt— �•�kl��-� f�� C'c��$zP�£i�i,�DrJ s'�,fi�enlf�G�. <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Forced air svstems <br />as nrepiace <br />as ranqe <br />Exhaust fan <br />Heat pump <br />Unit heater <br />f uucung <br />Other <br />SPRIIdKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />j Toilet <br />Bathtub <br />� Lavatory (wash basin) <br />sinK <br />�her <br />was <br />Sink (service/bar/m <br />Backflow preventer <br />rcoor arains <br />Medical Gas <br />Other; <br />Other: <br />n <br />� �.- <br />_ --- <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 granfing 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 wiih the State Contractors Law 18.27 RCW and 296200A WAC. <br />� J/ <br />� D.S �S ! <br />wnerlAuthorized Agent Signature D te (Revised 4/2015) <br />� i <br />. �� / <br />