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• • <br />PERMIT APPLICATIQN <br />E3lJILDING/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 />s:�`�1 �g Lo <br />PROPERTY TAX # PERMIT # <br />�0�-15a6Z�5`'1�Z.57�� �;��D�—�Z�_% <br />�L for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />> , c, <br />ER �•C�arn� �..� _� C.,.,,.., Phone/E-mail �ZS'-C��j � -' �j Gf / (� <br />�s � `'� � � L� r^, � �� ( CI � V � I City/State/ <br />ICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent <br />i /� , <br />♦ �i 1 .. -. ��: t� l',l.-- <br />ress 1 � �,,,/ � j ,t <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/E-mail <br />Te�Bfll (must provide a letter of consent from the owner �o do work in the space) <br />Citv Bus. Lic. # <br />Phone/Email �"� ZS '� j���—C� �j j`f <br />��.�f Qa.u��s LlZS -S�l� �S ��. <br />ONTRACT PRICE OF WO <br />Existing Use of Building S.,r..�\z �'�r.��._� <br />Proposed Use of Building Gas <br />Building type: �Single Family _ Duplex _Townhouse _ Multi-Family ^ Commercial <br />Type of project: New Addition � Remodel Repair _ T.I. _ Sign _Sprinkler _De <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />W C� C� �G�� (� 5 r`� 1'CU St'- L �r1V SV� `�/ <br />IT <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />i A/C - air handling units <br />Forced air systems <br />Gas pipinq <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ranqe hood <br />UIIIT Il2aL2f <br />Boiler <br />Refrigeration <br />Woodstove <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />Electric Other <br />olition Chanqe of Use <br />Type of Project: _New _Addn _Alteration _Repair <br />5how Number (#) of fixtures <br />� j Toilet <br />i Bathtub <br />� ; Lavatory (wash basin) <br />� ! Shower <br />� Kitchen sink & disposal <br />Dishwasher <br />Liotnes wasn <br />Water heater <br />Sink (service� <br />urinKing roun <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />i <br />I hereby certify that I have read and examined this appiication 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 authoriz d 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 />�-, <br />5 - �1-( -• � c' <br />Ownerl t iz d Ag nt Signature Date (Revised 4/2015) <br />�� 7 _ <br />v <br />