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� � � a. � <br />�'��.�A� �l� p�a���Q � <br />C�����I���/�f��G����9V���/�����1�9�/�S�N�/��G�a��L���l� �� II��I�p�'��� <br />� c��r�r o� �v�►����' ��ta�i�i s��v�c�� <br />3200 Cedar St., �veretf; WA 98201 �25-257-8810 FAX 425-257-8857 www.everettwa.org <br />����� s�'} ... � J 1'Vi.��[A_ t il. ✓ �i L� �.l 4� �<,.• <br />L�GAL, for new construction: 5hort PlaVsubdivision <br />OWNER �� . �'� �;{ �C�y�,iL1 t�.�.l�V u' �If.'�� <br />4ddress �"� '2�; �►i • p'�'�r-1�GIN'ti �� 4�=' 1��I.L <br />4PPLICANT: _ Owner _ Owner's Agent �, Contra�tor <br />�� <br />CTOR �. � <br />�i"��v <br />� - <br />�Yji.� `>(':?;J;{i <br />PROPERT(TA7( # <br /># <br />c <br />Lot No. (atfach copy of Ibng legal dE;scription) <br />�,,,�� Phone/E-mail 1-�'�� —27L' %� 1 � <br />City/State/Zip �:. V �-Y�1�; �,� o{ �l� �-, f <br />Cof7tfaCtol°s A�e�t _ Teflaflf (musi pr❑vida a le�ler of consoN from the owner lo dp work In Ihe space) <br />C����-� �-i7�lki� ����i��i�C <br />C..��(,L �1,1 G � � J �. I,l�t�� <br />� ( �-p ���C,.,�,����� <br />C� cr�v ��� S � <br />BUI�DING PERMIT ,APPLICATION <br />State Lic. #�j��-t��C��'�� C� City Sus. L.ic. #�C� " <br />� � � ( Phone/Email � Z� •- 2�� �, �,,'� <br />!��►i�t'i�� L �,�i'�i+i �-� -Ct►'�l <br />�one/E-mail �� � 2`� � � ��� � <br />ONTRACT PRICE OF WORK Z�'� ��� <br />Existing Use of Building t'Ji; L!-f�+,vi;c HEAT SQUI�CE: <br />Rroposed Use of Building ���'' �'�t�L` Gas Eiectric_� Other <br />Building type; ^ Single Family _ Duplex_Townhouse _ Multi-Family X Commercial <br />Type of project: New Addition _ Remodel � Repair_T.I. _ Sign _Sprinkler_Demolition_Change nf Use <br />DESCRIPTION OF WORK (additional space provided on the back) : / / <br />���'���-6 �`ti�'>7r1�'6 �j. ��� N�i.t`E"SLVs11l� ��v �.�LC�7`) w� 'j/4w�C C�H��(.7a%, 4G'i, )�l f'GC�:siK�'r� <br />/ / <br />L'r <br />CtJ,I <br />ofProjecf: _New_Addn _Alteration,�Repair <br />Show Number (#) of fixfures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Wat�r heater <br />Gas fireplace <br />Gas range <br />Clothes drye� <br />Range hood <br />Exhaust fan <br />�-- Heat pump <br />� Unit heater <br />� Boiler <br />� Refrigeration <br />� Woodstove <br />I Ducting <br />� Other <br />SF9I�SIt��SS�.�F� / �U������d��'I ��(���Qiil <br />Number of Heads <br />P <br />of Project: _,New _Addn ,_,Alteratio� _Repair <br />Show Number (#) of frxfures <br />I Toilet � <br />n <br />Kitchen sink & dispo�al <br />Dishwasher ' _ <br />Clothes washer _ <br />Water heater <br />Sink (seivice/bar/moF�/e <br />Backfloin+ prevenfer (il�s <br />llrinal <br />Raof drains <br />Medical Gas <br />Oth e r: <br />Other: <br />I hereby certifythat I have read and examined ihis applfcation and knoW ihe same io be lrue and correct. All provisions of laws and ordinances governing lhis lype of work will be complied <br />with whelher specified herein o� not. The graniing of a pe�mit does noi presume to give aufho�ty to violate or canr.el 1he provision of any other state or local law regulating cons(ruclion <br />That I am auihorized Uy 1he owner of lhis property to perform ihe wo�k for which application is made and I comply with ihe Siate Cont�actors Lav✓ 1027 RCN� and 2°6.2DOA WAC. <br />��..�c� �l � I� <br />9w�e�,4uthorize gent5ignature Dat� (Revlsed 4/2075) <br />. \� L/ <br />