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L <br />�ERIVIIi �4PPLI��i�1"I�� <br />�UILDING/MECHANiC�4�/PLl1M�ING/S9G�/��RIf�IK���IDEMOLITI�N <br />c��� o� �v�����i ���u��� ���vo��� <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SIfE ADDRESS: . <br />.��JCi� <br />LEGAL for new construction: Short PlaUsub <br />OWMER �C"J,SI� z. IU�TGiIJ E <br />Hddress 7V��� � <br />APPLICANT: _ Ovdner _ <br />coNrR�cTOR �v�,t'L <br />Address �..� �� <br />TEIVANT BUSINESS NAI� <br />PERNTA>(# PERMI #. <br />:m.� I S�a , <br />Lot No. (attach copy of long legal description) <br />Phone/E-mai1�2�(�> �(� 7,rj � ��3 <br />%Ul�l L� ��� �City/State/7_ip �7,-�-�, ,7} � 0 � <br />OWfl2f's Agent �ontractor _ Contractor�S AgB�t _ TEflBilt (must provide a letterof consentfrom the ownerto do work in the space) <br />C.-l""r 1 <br />�tJ11�DInIG P�RilA1T' �►PPl�iCA'TIOf� <br />�: f� � State Lic. # �,�� �• � p LZ�i—" City Bus. Lic. # <br />1�25� 'Z52 — 3 i � v: <br />Phone/Email <br />CONI'ACT FOR PERMIT <br />Kc,� 5�� � ��s� ��Z �t�y� <br />Phone/E-mail � " � <br />GON i RACI PRICE OF 1NOR �'t�/� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric� Other <br />�_ <br />Building fype: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New _ Addition _ Remodel ._ Repair_ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPT'ION OF WO�K (additional space provided on the backJ : <br />.—� <br />.�..e.��;�vt�.s-- '��1 2�v�, ��-�l�.�s l�-4c�c ��c.� `��s�u� <br />E110EEC�9AR11C�4L. �L�ldt;lllT A�'�LICA �8��! <br />e of Project: _New_Addn _Alteration _Repair <br />Shov� Numl�er (#) of fixtures <br />� A/C — air handling �mits <br />� Forced air systems <br />i. Gas piping <br />� Water heater <br />j Gas fireplace <br />� Gas range <br />� Clothes dryer <br />� Range hood <br />i Exhaust fan <br />�— Heat pump <br />__� Unit heater <br />� Boiler <br />� Refrigeration <br />( Woodstove <br />I Ductina <br />��l�IRlF�L�B� / SU�Pt3���lOP�9 ��"��i�� <br />� Number of Heads <br />P�UM�8�3G 6'Et�t�91' �4PP�SCAT106'd <br />Type of Projecf: _PJew _Addn _Alteration _Repair <br />Show Nurnber (#) of fixfures <br />; Toilet <br />� Bathtub <br />� L�vatory (wesh basin) <br />� Shower <br />� Kitchen sink & disposal <br />� Dishwasher <br />� Clothes washer <br />� Water I�eater <br />� Sink (service/bar/mop/efc.) <br />� 13ac1<flow preventer <br />� Urinal <br />� Drinking Fountain <br />� Floor drain <br />� Grease trap <br />� Roof drains <br />� Medical Gas <br />j Other: <br />� Other. <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. Th nling a permit does not pr2sume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized b the owner his property t perform the work for which appiication is made and I comply wiih the State Contractors Law 18.27 RCW and 296.200A WAC. <br />P �, _ (�— � — ' <br />Owner/Aut orized Agent Signature Date (Revised 3/2093J <br />