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�'���9`� �,��f�q������� <br />�u��������n�����r�������t��s����a������s�������������w�� <br />� CITY oF EVERETT P�RMIT SER1/ICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />�� (� � �LI� I `� � (` �-�F��- <br />n nno�c�. PROPERTY TAX # P(,��� �,.�, ���-�,.� <br />� �{k�� -� , x� ����,��-- Y-+��= � i � ��,� <br />4L for new construction: Short Platlsubdivision Lot No, (attach copy of long legal descripti�n) <br />OWNER <br />Phone/E-mail <br />idress I����state/�ip <br />PPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contracior�s Age�t _ Te�aflt (must provida a le�ter of consent irom 1he owner lo dp worh In 1he space) <br />ONTRACTOR J� I j ,,�y � ,� <, �j �,. V �l-�; �n �� LL � State Lic # � LL. � �q y�L�' 7 (oC (�p City Bus. Lic. # <br />"� C� `�--'�c� x � ) ) � <br />BUI�.DING PERMIT APPLICATION <br />Phone/Email �/ 2 � - � q '3 - <br />�one/E-mail �2 � - 2 � <br />ONTRACT PRICE OF WORK <br />Existing Use �f Building � <br />Proposed Use of Building <br />Building type: �ngle Family _ Duple Townhouse ,_ Muiti-Family ,_ Commercial <br />Type of project: _ New _ Addition _, Remodel _ Repair _ T.I. _ Si9n _Sprinkle <br />DESCRIPTION OF WORK (additional space provlded on the back) : <br />� y� -5 � d �� � \1 � � �� � , G ; .r, s � „-� a <br />� ,` � �-� � � r� <br />of Project: _New _Addn _Alteration _Repair <br />ShowNumber(#) offixtures <br />A/C — air handling units <br />Water heater <br />Gas fireplace <br />Gas ranqe <br />xhaust fan <br />eat pump <br />nit heater <br />. � Utlle� <br />r��cLe� i suPPa��ssro� �xs-r�nn <br />Number of Heads <br />'—Q v'i���T�T <br />HEAT 50URCE; <br />e of Use <br />�, o�.� t° r:� J-, c� \\ <br />Type of Project: ^New _Addn �,Alteration _Repair <br />Show Number (#) of fixfures <br />Toilet � <br />Bathtub <br />Lavafory (wash basin). <br />J � Shower <br />� Kitchen sink & disposal <br />Dishwasher ' <br />Glothes washer <br />� Water heater <br />' Sink (service/bar/mop/etc.) <br />Backflov,r preventer (inside bld� <br />llrinal <br />� Drinking Fountam <br />—` � Floor drain <br />� Grease trap <br />� Raof drains � <br />Medical Gas <br />Other: <br />) / Other: <br />I hefeby ce�tifythai I have fead and examined ihis appllcation and know ihe same io be lrue and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whelher specified herein or not, The graniing of a permit does noi presume io give autho�ty to violate or cancel ihe provision of any other state or local law regulating consiructlon <br />That I am auihorized by 1he owner of this prop rty io perfomt the work for wh7ch application is made and I comply with the State Contractors LaW 18.27 RCW and z96.2DoA WAC. <br />,�n ���l� �� - Z I -/ > <br />Owner/Rvthorized Agent Signatu e Date (Revlsed 4/2015) <br />�� �'� � `,—�(�Z <br />