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!�' ����� ������4�1��� � � <br />�����i���������o���������i����s��r�������������������� <br />� CITY OF EVERE7T P�R�III' SERVICE� <br />3200 Cedar St., �verett, WA 982Q1 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ADDRESS• <br />PROPERN TAX # <br />��-� �; � i� C�'T�� �2 � L� O�iN 1�- u!' ��'1h-I I 1 J_W I. �. <br />�L for new construction, Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />: � Owner _ Owner's Agent <br />� <br />Contfactor <br />BUILDING PERMIT APPLICATION <br />� �' � i� �'� � � � <br />� <br />- ,��i I,� � U , �c <br />s �;� ��Y City/State/Zip <br />CofltfBCtDI'S Age�t _ Te�aflt (must provide a letler of cvnsent from the ownef to dp work In ihe space) <br />Lic, # <br />Phone/Email <br />'ACT FQR PERMIT <br />IE-mail <br />'RACT PRICE OF WORK <br />Existing Use of Building � <br />Proposed Use of Building <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 (additiona! space provided on the back) : <br />� <br />Y'� ���r v� �-t, t�1(� F� l,�J,J�� r;�� �(1�;� �(�� l� <br />Type of Project: _New _Addn _Alteration _Repair <br />5how Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas pipin9 _ <br />� Other <br />SPRIWIKLER / Sl1R'P���S101d �YSii�M <br />Number of Heads <br />Bus. �ic. # <br />HEAT SOURCE: <br />Chanqe of Use <br />Type of Project: _New _Addn ,_,Alteration _Repair <br />Show Number (#) of �xfures <br />I Toilet <br />Kitchen sink <br />Dishwasher <br />Clothes was <br />Water heate <br />Sink (servicE <br />F <br />Medical Gas <br />Other: <br />Other; <br />I hefeby certify that I have read and examined this appllcation and know ihe same io be irue and correct. All provisions of laws and ordinances governing this type of work will be complied <br />wiih whelher specified herein or not. The granting of a permit does noi presume lo give authority to violate or cancel 1he provision of any other siaie or local law regulating consiruciion <br />That I am authofized by the o�r of this property to pertorm the work for which application is made and I comply with ihe Siate Coniractors Law 18.27 RCW and 296200A WAC. <br />�� �� �r ��,�� ��ai ! O fl�; � 1� <br />Ownerl uthon ed Agent Signature �afe r (Revised 4/2�95) <br />J <br />� <br />