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�����������a����� <br />��������� �����o���,�������������,���a���������������� <br />� C1TY OF EVERETT PERIlf111' SERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 42�-257-8857 www.everettwa.org <br />SITE ADDRESS: <br />� 5���-� �1�����f�� � f,�� <br />L�GAL for new construction: Short Plat/subdivis <br />OWNER <br />dfess <br />�PLICANT: Owner <br />CONTRACTOR <br />Address <br />Owner's Agent <br />Contractor <br />�' (/ � <br />�' �� ��� C ��`�i ��, cv'1 <br />BUILDING PERMIT APPLICATION <br />_ A <br />Tax # <br />No. (attach copy of Ibng legal description) <br />PhonelE-mail <br />City/State/Zip <br />Contractor's Agent � <br />State Lic, # <br />TeflBflt (must proyida a letler of consent from the owner to dp work in Ihe space) <br />Phone/Email <br />ONTRACT PRICE OF WORK <br />Existing Use of Buiiding i✓1/j��l %1�'-z�i/ (' � <br />! ,� � ,� �, <br />Proposed Use of Building �� Q-� �� �"� <br />Building type: � Single Family _ Duplex _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 />; ll�. ,l/l/l,�G[-�C, ,�1'�1'G� D ��� . �� s <br />ICAL PERMI <br />of Proje�t: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handiing units <br />Forced air svstems <br />ater <br />vas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Bus. �ic. # <br />HEAT SOURCE: <br />Chanqe of Use <br />of Project: _New _Addn ,_,Alteration _Repair <br />Show Number (#) of fixtures <br />Bathtub <br />l,avatory (wash ba� <br />Shower � <br />Kitchen sink & disp <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />� Other � Medical Gas <br />SPRIIvI�'CLER / SU�'PRESSlOtd �YSi'ENl Other; <br />Number of Heads Other: <br />I hefeby certify that I have read and examined this applfcation and know ihe same io be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein of not. 7he granting of a pefmit does not presume to give authority to violate or cancel ihe proVision of any other siate or local laW regUlaiing construcllon <br />That I am authorized by ihe owner of this property to pertorm the work Tor which application is made and I comply with the State Contractors Law 18.27 RCW and 29620oA WAC. <br />.�j,r�v�/ 'Z � /�j , <br />" " � /UJ �j �r1�� v �� � �/ Date (Revised 4/2015) <br />Owner/Authorized Agent Signature <br />