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( <br />_. � <br />. �'�RM1T APPL#C.A,TIC� <br />BUtL.DING/MECHAMICAL/PLUIV��ING/StCNISPRINKLER/DEMQl,ITIC�N <br />'� CITY OF EV'ERETT PERMIT SERVICES <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.vrg <br />TE ADDRE55: <br />1215 Madrona Ave., Everett, WA 98203 <br />ROPERTY THl( � <br />00505700003702 <br />for new consintction: Shori PlaVsuhdiv#s(on Lot No. (attach copy of ibng legal desorfption) <br />Dennis and Kathleen Gustafson <br />1215 Madrona Ave <br />: X Owne� _ Ownei"8 Agent <br />PhonelE-mail katdrd@comcast.net <br />Everett, WA 98203 <br />Contractor _ Contractor's AgeTrt _'Tenant (mu�t Prwrde a Ieuer w consaM trwn ihe owner w dp wnrx in ine space} <br />17106 128 Lane NE, Woodinville, WA <br />UII.DING PERMIT APPLICAT101V <br />L(c, # ADVANFS903DH Ciry Bus. �ic. # <br />PhonelEmall 206 852-2450/howard@founda <br />Kathy Gustafsonl425 339-1571/katdrd@comcast.net <br />PRICE OF WORK ` <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type: „ SEngle Family ____ Duplex _Townhouse _„_, Mut�-Family ,,,,_ Commercial <br />Type of project� New Addition Remodel Repair T.I. Sign Sprinkle <br />—_— <br />DESCRIPTIQN QF WORK (adciltiona� spece provfded on the back): <br />RETAINING WALL . <br />ofProJe�t; _New_Addn Alteration,_Repair <br />Show Numbe�) of fJxfures <br />�� A/C — air handlin�a units <br />R/SUPPRESS <br />Number of Heads <br />HEAT <br />Use <br />oi project: _,New�Addn Afteration _Repafr <br />Show Number (� of fixtures _ <br />Medical Gas <br />Other. <br />� <br />I hereby certify that I have mad and examined ihls appBcatbn and know ihe same fo be irue and correct. AU provisbns of 1� end oMinances gnveming ihls type of woric wN be complied <br />wHtt whether sp�d herein o� not. 7he granting of a petmii does not presume io give authoriry to vlolete or can�ellhe p[oy�sion of any other staia or locel laW regulating construclion <br />That i am authorfzed by the owner of this property to perfortn the work for which appGcatlon Is mede and i eomply with Yhe State Contractors Law 18.27 RCW and 2s8.20oA WAC. <br />' - , � � -" , ca ' (�� � , <br />Own Aut o ze. gent5ig ature 4 ae (Revised4/2015) <br />. � <br />1 7 <br />�i <br />