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� � � I�I�q�/�`��� <br />��� �� � <br />��I��I��/(�i�����1���/P�.�J�111�1�9�/�1�I�/��RS�����/��6�1��1`il�� <br />' CITY OF EVERETT P�RI�I1T SERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everetiwa.org <br />�EADDRESS: PROPERTYTAX#i ttt'v ' �r <br />� �� �� �fr�'�.� ��'�.�� h�� s�so�a s��a �o � i � I I � �� <br />GAL for new construction: 5hort PlaUsubdivision Lot No. (attach copy of Ibng legal descriptiDn) �� <br />VNER jJ Phone/E-mail ' d��� Q U�� <br />, 1 <br />lress � � L�� -- <br />City/State/Zip � �oZQ <br />PLICANT: Owner ' wner's Agent _ Contractor _ Contractor�5 AgB�t _ Teflaflf {must provida a letter of consenl from the owne� lo dp work In the space) <br />r� � <br />�NTRACTOR / �' �( State Lic. # Q l� �� t.'' �-G 2U City Sus. Lic. #�j �✓�J�� ' <br />_ � �, <br />ire�s �'�� �� ��; ���� Phone/Email <br />�v��--s�� iC/r��` 9'��// �� <br />BUI�.DING PERMIT APPLICATION <br />y�.� � <br />e/E-mail � ,-�G <br />ITRACT PRICE OF <br />Existing Use of Building � !3 �v ��s` r�- �� <br />Rroposed Use of Building ���Sf/ d✓��� ��� '�--� �as_ <br />Building type; � Single Family �Duplex,_Townhouse _ Multi-Family Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.I. _ 5ign ._Sprinkler ____De <br />DESCRIPTION OF WORK (addifional space provided on the back): j� �� �(����.,•�� � S 1��� <br />Type of Proje�t: _New _Addn _Alteration _Repair <br />5how Num6er (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Wat�r heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />� Exhaust fan <br />Heat pump <br />Unit heater <br />� Boiler <br />� Refrigeration <br />� Woodstove <br />� Ductmg <br />. � Other <br />SPRIT��L.ER 1 SUPP�tESS10Pd �V'�TEM <br />Number of Heads <br />� � <br />, i. <br />� 2.�=,D G' ° � _ <br />HEAT SOURCE; <br />�ctric Other <br />olition Chanqe of Use <br />of Project: _.,New _Addn ,_,Alteration _Repair <br />5how Number (#) of fixtures <br />I l'oilet <br />sink <br />�her <br />Sink <br />r�oor arain <br />Grease trap <br />Raaf drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby cerfifythat I have read and examined this application and knowihe same to be irue and correct All provisions of laws and ordinances governing this lype of work will be complied <br />wiih whether specified herein o� not, The granting of a permit does noi presume io give autho�ty io violate or cancel ihe provision of any other siate or local law regulating consiruction <br />That I am auihorized by ihe owne of thi,� property to perform ihe work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.2DOA WAC. <br />% �,%/�-✓1�.---� f /6 �S^ `' <br />� / Date (Revlsed 4/2015) <br />OWher/Authonzed Agent Signature ,s�I �\` a'� � <br />'tt' ....)lj � Z- <br />