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From: • 07/0�/2014 11:29 #119 P.002/005 <br />• � � � �� � <br />��� �� ������ �� � <br />��������a/��C�������/��.�i�����/5���/5������.��/������T��� <br />CfTY OF EVERETT PER1VEli SERVICES <br />3200 CedarSt., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDR�S • s� PRopea�rpT�ax� ��) <br />f � :S� � � - �. !7� l/ � J�'C � PERMIT # <br />a ' � 60 <br />LEGAL for new construction: Short PfaUsubdivision Lot lJo. attach co <br />� �,p ( py of long lega! description) <br />OWNER ��J�� ` �(,� �(/`/J [/t � Phone/E-mail � � � ,.,,. �% � � <br />Address � � �'S .'�? � � � ��� � <br />City/State/Zip � � � Q� y+,, <br />� V <br />APPLICANT: _ Owner Owners Agent �Contractor _ Coniractor's Agent Tenant m�n <br />( p�vide a IeHer of consenl ftom Ihe owner to do wodc in 11te apacej <br />CONTRACTOR ���-t"-,l ,�`�' �`�1 .� a L 8, I Lic. #� S�� `�;+\�, <br />� l\�" I`f ��� COE Bus. Lic. �t � Cj 3 <br />Address ��T1i1S North C;reek`Parkwa Soufh Sl �C-106 Bothell WA 98011 I^ <br />TENAMTBUSINESSNAME � � -ma��� 5��� �Y1E��l`�-��( � <br />CONTACT FOR PERMIT �%� � ��n� � � <br />�� 1�� �'� � <br />Phone/E-mali n9._.,r � �` <br />�-t �CZ <br />�������� ����C� �������T��� CONTRACT PR�CE OF WORK <br />Existing Use of Buifding !-iEA RCE: <br />Proposed Use of Buitding Gas Eiectr�c other <br />Building type; � Single Family _ Duplex _Townhouse Multi-Family � Commercial <br />T e of project: _ New ,_ qddifion Remodei , Repair � 7.1. � Sign,S rinkler Demolition Change of Use <br />DESCRIPYIO/d OF WORK (additronal space provided on the back): <br />�� Qnn,�,t, v E �� I��'.� ( C:� (..� OL-Q�./�' �.s�.��!�' <br />f�ECB�6I�E�CAL ��Ft1i�IT �dPP�ICf�'i'fOF�I 6�LU�1l��Pld's P�RMI� �lPP�,¢Css'i'IO�f <br />Type of project; _New�Addn Alteratlon�Repatr Type of Project: New Addn _Atteration,_,Repair <br />Show Number (#) of fl�rfures Show Number (#J of fia7ures <br />E A/C -- air handling units 7oilet <br />Forced air systems 8athtub <br />Gas piping ' Lavatory (wash basin) <br />Water heater <br />Gas fireplace Shower <br />Gas ran e <br />Kitchen sink & disposal <br />Ctothes dryer Dishwasher <br />� Range hood Clothes washer <br />Exhaustfan Waterheater <br />Heai pump Sink (service/bar/mop/etc.) <br />r Backflow preventer <br />Unit heater Urinal <br />Boiler <br />Refrigeration <br />Drinkih �ountain <br />Woodsiove Floor drain <br />Ducting • Grease trap <br />Other <br />' Roof drains <br />I Medicai Gas <br />�l��E���E� / �i��is�E�SEOP� ���TEfdG <br />Other: <br />Number of Heads Other: <br />I hereby cerliry that I have read and examinetl fhis appfication entl know the same to be true and correcL Ail provisions of laws and ordinances goveming t�is type of work wiil 6e complietl <br />with whetl�er specified herefn or nvL The pranling of a permit does not presume lo qive authoriry to violale or cancet �he provision oi any other state or local law requialing construclion <br />That I am authorized by the owner otthis property to peAorm the work for which applicalion is maqe and I compy with the Slale Contractors t,aw 18.27 RCW and 296.2tl0A WAC. <br />�C��.�r� �j `� <br />Qy�r�eY!lSuthonzea r.yr�,� ,,,y,,,.,ure �ate <br />e (Revised 6/2012) <br />