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� p���9`� <br />� <br />�,pG�L aC� °; `���� <br />��o��o��i�����a�o�����������������r���a����������ap����� <br />' Cll"Y �F E!lEF�ETi' P�Rfifll`� S�RVICE� <br />3200 Cedar St., �veretf; WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />PERTY TAX #i <br />C�: <br />L�GAL for new construction: Short Plat/subdivision Lot No. {attach copy of Ibng legal description) ' <br />OWNER �� � ��'y'L �,�' ia-�-1 � �,. PhonelE-mail ����j ���1'�j�'f — �77 <br />Address � s' �„^('„C-� �-C.C:2L�.�°� City/State/ZiP � G1„i l � A � � %C. <br />APPLICANT; _ Owner _ Owner's Agent ,�, Co�ffaCto� _ CofltfaCi0i�5 Age�t _ Teflaflt (must provide a letler ofconsonlfrom the owner lo dp work In Ihe space) <br />ONTRACTOR �V����^(��L-� �'STIkT, <br />ldress ����'.� �C.-j��� s�,l�� �V <br />/ , , <br />,LI ( ��c:�i�-�?� �' i, ' <br />BUI�DING PE�2MlT a4PPLICA ON <br />!�� State Lic, #���t�-�C?��.� e City Sus. L.ic. #�ilr" <br />�(,t l� � � 2� ( Phonel�mail � �.� .- 'Z�`Z � � � �i <br />�7��- 2-�'� - 3�� � �.i•��� �'�,�, N -�,,�r : �o��. <br />ione/E-mail <br />ONTRACT PRICE OF WORK � /�L;��` <br />Existing Use of Bullding /5/L� C d��'�� �� HEAT SOURCE: <br />Froposed Use of Building �y�' ���'�`� ` Gas_ Electric iC Other <br />Building type: � 5ingle Family _ Duplex_Townhouse ,_ Multi-Family ?t Commercial <br />Type of project: New _Addition _ Remodel 5� Repair_T.I. _Sign _Sprinkler_Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): P ' <br />I,�i:,�/iL��'c " Z��-�',� r�'��. � �Z�%��7 dsll `l� �'l�7�1�%� L%<r�'"r.0 I4 � � i-Gr .W rz `�i f 6+� '.�,���. ��R1-G;_ <br />t r" <br />� � � �`"ti[(iJ�-Yb �- /�'"' �� l- [ ��G1�%!�. (i4rL � " ��"C�/ .�i'N�' 7� �'�%- ����ti /��i �f'�.�� C ��c}C6'.�% �:.'�L i:)�(�..G i .G'-a.1���G'• <br />1 <br />PP <br />Type of Projeci: _New _Addn _Alteration�/ Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />� utner <br />P�' �SL,�� / a��Fe�'Ld���d��9 ��i�'��6!!1 <br />Number of Heads <br />PERMI <br />of Project: ^New _Addn ,_,Alteration _Repair <br />Show l+lumber (#) of fixfures <br />l"oilet <br />Bathtub <br />� � Lavaforv (wash basiN. <br />5nower <br />Kitchen sink & c <br />Dishwasher <br />CIotF�es washer <br />Water heater <br />Sink fservice/b� <br />Fo <br />�rease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />r <br />I he�eby certify ihat I have read and examined ihis appllcation and know ihe same io be irue and correct. All provisions of laws and ordinances governing this lype of work will be complied <br />wiih whelher specified herein o� not, The granting of a permit does noi presume to give authoriiy io violate or cancel ilte provision of any other siaie or local lav✓ regulaiing consiruction <br />That I am auihorized by ihe owner of fhis property to perform the work forwhich application is made and I comply wiih ihe Siate Contractors Law 1�27 RCW and 286•2��A WAC. <br />,-�,�C.�'�'-�� � -j y - i � <br />�srrrer/Authoriz Agent Signaiure Date (Revlsed 4/2015) <br />��Z <br />