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rERMIT APPLICATI� <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOL,ITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: PROPERTY TAx # PE IT # <br />��z 3� '� S-r �'�r,�, ti, ���� �.,�5 z� i C�G' L(, �� � I�7 � - C�C%--� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />OWNER �, ti�C' � -Pca f� W� � J�� Phone/E-mail � Z] - 7� �" 3�(�z Z �1U ����n U r �� ln �- ] ��� � c_ rv�c, ,' � t � <br />Address f� Z 3 ��� � t City/State/Zip — � z � t' ��✓f1 �( ���j J <br />APPLICANT: Owner _ Owner's Agent �C Contractor _ Contractor�5 Age�1 _ TeflBfll (must provide a leqer of consent irom the owner to dp work In the space) <br />CONTRACTOR ��, `� j, 5� i State Lic. # Z, S� b i� Gity Bus, Lic. # j �)�J j <br />ress '�'�U-) �ve'ifPc– W�•n L�v�'�c'f� "/.4 �/S�L� <br />� <br />�,'�,� `�' � r( �i � l�'-+ .�%i. � w: /! C-� � � �� t'� <br />� <br />BUILDING PERMIT APPLICATION <br />3 Phone/Email��z,=�►3�-y3�� `I�1N-{�u��s•�s��.c <br />hone/E-mail <br />ONTRACT PRICE OF WORK <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type: � Single Family _ Quplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkle <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />�� �v`i- 1 ne•:� �.�.,, �., '�ry w�.� f S� t�� �� �`�`�C %��;,�I �'��� <br />of Project: _New _Addn _Aiteration _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 ranqe <br />Kange nooc <br />Exhaust fan <br />Heat pump <br />Unit heater <br />e <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />1 <br />HEAT SOURCE: <br />_ Electric_ Other_ <br />olition Chanae of Use <br />Type of Project: _New _Addn ^Alteration _Repair <br />Show Number (#) of fixtures <br />Snower <br />Kitchen sink & di: <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar! <br />Backflow preventi <br />Urinal <br />Drinking Fountain <br />Floor drain <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 ihe same to be true and correct. All provisions of laws and ordinances governing lhis type of work will be complied <br />wilh whether specified herein or not. The granting of a permit does noi presume to give authority to violale or cancellhe provision of any other state or local law regulating consiruclion <br />That I am authorized by the owner of 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 />� `",-✓-`- % �l 2 Cl / � <br />qw er/AuthorizeQ-�4 'gnature Date (l�evised 4/2015) <br />