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, ������ � �� ��o���a� <br />��I��IN�/iU���l���l����/����7�0�9�/���h�/�����1����1�������i �Oo� <br />�e�v ��' �v����� ������ ���v[��� <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereffwa.org <br />f� ADDRESS: <br />L�GP�L for new construction: Short PlaUsubdivis <br />OWME� �,%�,7(�) L <br />Address �'f"�� �� <br />APPLICAI�lT: _ Owner <br />CON�"RAClOR ��1�•,d <br />s �-I Z� <br />Ni BUSINESS NAM <br />P E RT`( TA>[ # <br />ERI�iIT <br />� <br />No. (attach copy of long legal description) <br />Phone/E-mail <br />J'��'t��L-�rl �U� ICiiy/Stafe/Zip ��:e�l�(�,` f= �i L'� _ ! U L'��� _ <br />OWi10f'sAgent �Contractor _Contractor�SAgBilt _TBn2ilf(muslprovidealellerofconsentfromtheownerlodoworklnlhespace) <br />�; /a (� . � State Lic. # <br />Bus. Lic. # <br />� ` 1�25� Z`�2 -3 i ►� <br />t��.��� Phone/�mail _ __ <br />J CONI'ACT FOR PERMIT � <br />�c��3 �tsc� C ��5 ) �5'2 =���� <br />Phone/E-mail jtii�;,�,r-� l�ti�s'Y)%il,(.,L�/ <br />�UO��IP�C� ���€��`� ��G��a��5����'1 <br />co�r�Ac i �RicE oF <br />Existing Use of Building � <br />Proposed Use of Building <br />Building fype: 7�Single Family _ Duplex �Townhouse _ Multi-Family _ Commercial <br />Type of project: New _ Addition _ Remodel ._ Repair _ T.I. _ Sign _Sprinkler <br />DESCRIP7101V OF WOP.GC (additiona! space provided on the backJ: <br />�-=�.e.�zr�%�S N L�t�`,":�� `J-l�• 1-��� i��.� �e� e � TT✓ C�e�/ 5 i7/l.:tb <br />660��C�9�L�1C�AC� ���4���' ����9�A� 9�� <br />Type of Project: _New_Addn _AlferaYion _Repair <br />ShowNumber(#) offixfures <br />� A/C — air handling units <br />� Forced air systems <br />� Gas pipiny <br />� Water heater <br />� Gas fireplace <br />� Gas range <br />� Clothes dryer <br />Range hood <br />� Exhausf fan • <br />� Unit heater <br />� Boiler <br />� Refrigeration <br />� Woodsfove <br />� Ducting <br />I O'ther _ <br />��E�IR9f�! ��e / �i��������1�6� ����'i G�,� <br />� Number of Heads � <br />HEAT SOURCE: <br />Electric X. Other <br />emolition _ Change of Use <br />� � S 1 Z�'�.r� <br />�@���fI�O�G �'���ld9`�' f��������9�R�! <br />TyE�e of Projecf: _New _Addn _Alterafion _,Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />I Lav�torv (wash basin) <br />Sno�ver <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />f3ad<flow preventer <br />Urinal <br />Drinking Founfain <br />Floor drain <br />Grease frap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify tfiat I have read and examined this application and know the saine to be true and correct. AII provisions of laws and ordinances goveming this type of work will Ue complied <br />with whether specified herein or not. The granting of a permit does not presume to. give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am auihorized by the owner of this pro to perform the work for which applic�dion is made and I comply with the State Contradors Law 18.7_7 RCW and 296.7_OOA WAC. <br />.i" ) <br />- e� /�� - i �Z - f�5y� ; <br />Owner/ uthorizec Ayent Sig ' ure Date (Revised 3/20'13) <br />