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� <br />� <br />L.J <br />�����'u�� ����������� <br />C��QL�����/�C�1����9nC���/�'���f��9�1�/����I�PG�a��f��G�3/�� Il��aO���� <br />� ci��t o� �v���� � ����i� ���vt��� <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX Q25-257-8857 www.everetfwa.org <br />SIT� ADDidES� � <br />l(.r�(f� I ����� , �P��� � <br />L�GAL, for nev✓ construciion: Sflort Plat/subdivision <br />OWNER ,�Q�"�CC� �r ��'i'� �G�CG��J UCC l` <br />Address � � � (�% P� j'!� �S L ` <br />APPlICANT: Owner _ Owner's Agent Goniractor _ <br />co�vz�Ac7o� �:;�'�jo����-�� ��'���Q <br />4ddress ��'�� �d�6,� {��1 r-�' ,� �- li <br />�UI�.DING �'ERMIT ��PL.ICATI(]N <br />I vC,Y����C�'��'C�-�t; � I . ��'� � � ���" 4' � p, <br />Lot No. {attach copy of long legal description) ' <br />Phone/E-mail � ?��,�i' ��%% �� ���Ci��J <br />City/Sfafe/Zip � �j"��� ��j ���� <br />Co�ffaCtoi'S Age�f � Te�alll (mus( pr❑vida a le4er of consenl from the owner la dp vrodc In Ihe space) <br />�C`��_� Stafe Lic, #�,��E�s-���`'��� � e� City 13us, l.ic. #�(✓ <br />�,[,t•(� �G `� Pl� ( Phone/Email � �';� � 'Z�� � � ] t/ <br />Phone/E-mail ��� ���✓�� �! / / <br />COIdTRACT PRICE aF WORFC �—�i. ° � <br />Exlsiing Use of Bullding i'Cl ����1 L I l7[�✓/ � <br />Proposed Use of Bui ding <br />Building type; ,_, Single Family _, Duplex�Townhouse � Multi-Family ,_ Commercial <br />Type of projeci: _ New _Addition _ Remodel ✓Repair=T.l. _ 5ign _Sprinklei <br />DESCRIPTION OF WORK (add�tional space provrde on the backJ : <br />� �►�.s� l� s�.►� �e -�� c���lc�ss i�G�+-���.��-�� <br />M <br />of Projecf: _New �Addn '� Alteration _Repair <br />ShowNumber(.#) offixfures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waf�r heater <br />�as range <br />Clothes drve� <br />n <br />eaf <br />C�7 <br />� Woodstove <br />I �ucting <br />. � Other <br />a�i�l�IF�J" G�L�� / ��➢�&�t�[������'t� ��(��1'��if! <br />Number oi Heads <br />HEAT SOURCE: <br />Electric�� Other <br />olition_Change of Use <br />V117' �PNLIC�#TI�1 <br />o� Project: _,Nevr _Addn ,_,Alferation _Repair <br />Sho�v Number (�) of fixfures <br />Bathfub <br />Lavafory (wash basin). <br />5hower <br />I<ifcf�en sink & disposal <br />Dishwasher ' <br />Clotf�es washer <br />Wafer heafer <br />Sink (seNice/bar/mop/et <br />Backflov� preventer (insii <br />Urinal � _ <br />Urease trap <br />Raof drains <br />Medlcal Gas <br />Otiter: <br />Other: <br />I hereby certify th�t I have r�ad and examined ihis appilcation and know the same to be irue and correct. All provisions of Iaws and ordinances governing lhis lype of v✓ork v✓ill be conolied <br />witl7 whelher specitied herein or not, The g�antin9 of a pe�rnit does nof przsume to give aufhority to violafe or cancelihe provision of any oihe� siate oi local IaW regulating consiruc(ion <br />That I arn ulhorized Uy ifte ownef of this property io perform ihe Wo�k fo� tvhich application is made and I comply wiih ihe Siate Contfactofs f_aw 18.27 RCW and 296.2DOA WAC. <br />� � „ �' �� / � <br />Owner/Authorized Agenf Signaf re Date (Revised 4/2�15) <br />