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s <br />�ERIVIIIT° �4P�LICi4Tl0� <br />�UILDIIVG/MECF�Af��C�4�,l�LUM�Ift!(�/�IGR�/S�RI�1K���ID�MOL1�10� <br />CIiY OF �V�R�i`T �ER�II�" ���i01��� <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 �nnvw.everetiwa.org <br />SI�'E ADDRESS: �Z l <br />LEGAL for new construction: Short PlaUsubdivisio <br />� <br />Address <br />PROPERTYTAX# <br />Phone/E-ma <br />APPLICAPIT: _ Owner _ Owner's Agent �Contractor _ Contractor's Agent _ <br />COfV7RACl'OR �<.1�<',dL�12�=Z:tJ tJ"�,�T�. E�Er1'� �,� �., State Lic. # <br />Address Z.� �� �'�L���,,, <br />TEfJANT BUSINESS NAME CONI'ACT <br />rt�� ��1t� < ti-�5) ��2 �fly- <br />Phone/E-mail - <br />CONf62ACr PRICE OF WORK �, ��%, ' <br />PEnUIII�� �' ��1C C� <br />No. (aftach copy of long legal description) <br />`� ZS) 2-S Z-�d tf � 2 <br />C-_v��--�- 1�.�� . '�4�?r� I <br />_ 1�8118f1i (must provide a letter of consent from lhe owncr fo do work in the space) <br />ail <br />—:3 i i�1 <br />Citv Bus. Lic. # <br />�llILDII�(9 P�RE1fi9�' APP�IGA'TiOf� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Eiectric� other_ <br />Building type: � Single Family _ Duplex ,_Townhouse _ Muiti-Family _ Commercial <br />Type of project: New Addition Remodel . Repair �T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the backJ: <br />.��s�u.._ 2�2�-� l� �l�>> (��7 1���� S�s zy� <br />��cb��ae�a� ���e�7ir �,����cA�so� <br />Type of Project: _New_Addn _Alteration _Repair <br />Shov�✓Number(#) offixfures <br />� A/C — air handling unifs <br />� Forced air systems <br />Gas piping <br />� Water heater <br />� Gas fireplace <br />� Gas ranye <br />� Clothes dryer <br />Range hood <br />� Exhaust fan <br />Heat pump <br />� Unit heater <br />� Boiler <br />� Refrigeration <br />� Woodstove <br />I Ductina <br />SPL�II�lf�CL,�� / Sll�{�R���I�PJ �Tf��'�N� <br />� Number of Heads <br />��uM�a�� ���nns°� �a���ec�-�so� <br />Type of Projeci: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />I Bathtub <br />Lavafory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <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 governing this type of work will be complied <br />with whether specified herein or not, The granting of a permit does not presume to give a�rthority to violate or cancel the provision of any other state or local lav✓ regulating construction <br />That I am authori d by the owner of t' ope y fo perform the work for which application is made and I compiy with the Stafe Contractors Law 1o27 RCW and 29G.7_OOFl WAC. <br />1� � �" '� � � � � � : J <br />Owner/Authorized Agent Signature Date (Revised 3/2o93) <br />