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— � ���nni-�����i��-ri� <br />�u���o�����c�����,��,��un����������os������������o������ <br />CIiY OF �OO�R�ii ����'lli ��C�\OIC�� <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SIfE ADDRESS: t,,, l� �_�� ���� �PROPERTYiA)<# I�P�I�#���� <br />�l �'�" 1 <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWfdEt2 ��C. l v� �� 4�(z-� Phone/E-mail `t'�S � � �— �5 <br />���"�" � � �: "� K � ;�1�L. Y P fl.�C��. � t/� . �. <br />Address � Cit /Stafe/Zi <br />APPLICANT: _ Owner _ Owner's Agent � Contractor _ Contractor�S AQ81lf _ TBf12Clf (must provide a letter of consent from the owner to do work in the space) <br />CONTRACjOR �vi-'1LF;CZIZtJ «`tf�T� �iC'.i�'� �.��. State Lic. #L,�L2(;�jQLZ.�; j- Cify Bus. Lic. #GC7`T�Stij <br />Address Z,.�l'z� �'}Ll'�j <br />TENANT BUSINESS NAME <br />�u��Di�� ���n�a� �►���ac��r�o� <br />—_3 i �v� <br />�'�� 5�� C ��sa �52 =�/�y� <br />Phone/E-mail <br />CON i RACl" 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 _Sprinkler <br />DESCRIPTION OF WORFC (additional space provided on the back) : <br />�a+.'`��1�' l.L_ � � � L (-%V---� = (�%�-=�—�1(-=`rj� �-t�� �t�%�4r� <br />l <br />n��c���ao��� ����Ar ����ec��sao� <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />� A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />i Water heater <br />j Gas fireplace <br />� Gas range <br />� Clothes dryer <br />Range hood <br />� Exhaust fan <br />Heat pump <br />� Unit heater <br />� Boiler <br />� Refrigeration <br />( Woodstove <br />� Ducting <br />� Other <br />�Pt�IRIKIe�f� / Sl���t����l��➢ ���i`i�iilli <br />� Number of Heads <br />HEAT SOURCE: <br />Other <br />olition Chanqe of Use <br />�@����0�� �E��S'�' ����SC��a�� <br />pe of Project: _New _Addn _Alteration _,Repair <br />Show IVumber (#) of fixtures <br />; Toilet <br />� Bathtub <br />� L�vatory (wash basin) <br />� Shower <br />� Kitchen sink & disposal <br />� Dishwasher <br />� Clothes washer <br />� W�ter heater <br />� Sinl< (service/bar/mop/etc.) <br />� [3ackflow preventer <br />� Urinal <br />j Drinking Fountain <br />� Floor drain <br />� Grease trap <br />� Roof drains <br />� Medical Gas <br />� Othei: <br />� Other: <br />I hereby certify thai I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this type of work will be complied <br />with whether specified herein oi' noL The granting of a permit does not presume to give authority to violate or cancel the provision of any ofher state or local law regulating construction <br />That I am authorized by lhe owner of this properfy to pertorm the work for wltich application is inade and I comply tvitft the State Contractors Law 18.27 RCW and 296.200A WAC. <br />-� <br />% <br />r' �' _ � , � � <br />!� <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />,�L <br />