Laserfiche WebLink
� � �o� a �� ��o�a�no� <br />�� Md�o a��C�/���G�, ��C�Q�4'� �M�l� �� ���C�9�OC����G�G�3fl�G��� ��D��i�����1 O�G`� <br />�I`�Y �� �������i p�k�Gl�d�`� ��G�V��C� <br />3200 Cedar St., Everett, WA 98201 4-25-257-8810 FAX 425-257-8857 www.everettwa,org <br />I i � l�DD��SS: <br />4 � I'7_ �� <br />for new consfniction: Short Plat/subdivis <br />. � � � e, <br />7 <br />n <br />ROPERIYiA>C# <br />Lot No. <br />PhonelE-mail � <br />_ � �� ►'�7 <br />� <br />(atfach co�y of long legal description) <br />25Z— 33/5 <br />R� rr l �/A �'�S'71�3 <br />n����C(�{� I:_ OWnel' _ OlNI18f's Agent �Contractor _. Contractor�5 AgEnf =T0Il811f (must provide a letter of consentirom the owne� fo do tvork fn Ihe space) <br />CONYF:I�C i OR <br />dress ��l �Lf.� <br />:NAN i F3USII�ESS (��1f1 <br />I��10 +� �� �G`�C� G''�LoVli��i'i '� G'G'�OC�'� 1��00 G� <br />Existing Use of Building <br />� f'� fc ISfate Lic. #(:�pa�g��.;��7'�?_��p � City Bus. Lic. # <br />° \P"o�''z�J, '�J � -' ;''J 0 1 °�-fr <br />IPhone/Email _ <br />— co��'Ac i ro�: ��Rn��eY <br />���,� �`���� < ���) �2 =�i��i <br />Phone/G-mail (-;� ��� «� ��� �%G' , G�/1 e�r/l <br />GON I I�AC-f i'I?ICE Or= I1110F:{< <br />Proposed Use of Building ' . <br />Building �ype: �Single Family ._. Duplex �Townheuse _ Multi-Family _ Commercial <br />Type of projecf: _ New ._Addition _ Remodel ._ Repair_ I.I. _, Sign _Sprinkler <br />D��Ci�IF��(OIl� OF WOf��C (additionaf space provided on the bac�k : ��� <br />�� E:`YtT l�l iNt j,�' 'i-U r'�� 1�kT �.t.u�� �.%�1.J4,�C.�al=: r <br />���C��d����� P���V�d9�i LQPG'�0��`�@��� <br />pe of Projecf: _New_Addn �Altera <br />Sh ow Number (#) of fixfures <br />� A/C — air handlin <br />� 1=orced air sysfer <br />� Gas piping <br />� Water heaier <br />( Gas fiireplace <br />� Gas range <br />� Clothes dryer <br />Range hood <br />� �xnaust fan <br />� Heat pump <br />) Unit heater <br />I Boiler <br />n _Repair <br />unifs <br />� Woodsfove <br />� Ducting <br />I O'ther <br />���6�OL��'S1f��C;l / ��9G'[�G�3�5��00 f� �r(�il <br />� Number of Heads _ <br />NEAT SOURCE: <br />Gas Electric� Other_ <br />Demoliiion_Change of Use <br />d ��9����G�� ��G�����' ����a��5�0�� <br />Typeor'i'rojec4: _,New^Addn _Alieraiion_,Re��air <br />ShowNumber(#) offixfures <br />� � ollet <br />� E3�tthiub <br />� Lavafory (wash basin) <br />� Sf�ower <br />� Kifcl�en sink & disposal <br />I Dishwasher <br />� Clothes washer _ <br />� Wafer f�eater <br />i <br />� Sinl< (seivice/bar/mop/efc.) <br />� Bad<flow oreventer <br />� Urinal <br />j Drinicing Founfain <br />� Floor drain <br />� Grease trap <br />� Roor` drains <br />� Medical Gas <br />� Other: <br />� Other: __ <br />I hereby certify that I have read and examined this application and know the same to Ue true and correct. All provisions of laws and ordinances governing ihis type of worl<will be comp�ied <br />with whether specified hefein oY not. Tfte araniing of a permit does not presume to give authority fo violate or cancel the provision of any oihef state or local law regulating construction <br />That I am autl�orized by �e owner of this pro rfy [ perf'orm the work Torvdhich application is made and I comply tviih ihe Sfafe Coniraciors Lavd'16.2! RCW and 29G.7_00� AC, ' <br />, , . ���.� <br />a � �� <br />Owner/Auihor ed Agent Siynatur <br />Dafe (Revised 3/2093) <br />