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m <br />�I•> � T `� ��) � C� J� I`. <br />, I , / . i I- - i- � _ <br />��������������11�1V���/°4:�/��WN��/1����������/������@��������N��� 6 ����Ml <br />b�! Y �� �►7����� ��[Rtl'�b�� a�6���4��e� <br />3200 Cedar Sf., Everett, VV,4 98201 425-257-8810 Fl�X 425-257-8857 �.@V�P�Y�UVa.OPg <br />E �aD�RESS: PROPER3V T/�( � <br />� � � i ��h'� �v� r�J �� s�-r,�� /3a a��y� �������� � �� � � - �Z�a <br />'s�L for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />RIER ' 3 w�C'rlv����� �"�`'�y=1 �-C Phone/E-mail <br />�ess G$yC� �r f "��� (� — �� f` 3SD City/State/Zip �w��.� �i{� 9'Bf$�•j <br />�LICAN7: _ Owner _ Owner's Agent �/COf1if8CtOf _ CpfltfBClOf S A92nt _ T0f18f1i (must provide a letter of consent hom the owner to do work in the spaci <br />JYRACTOR uI,/ q� /� py froec State Lic. # L,/�/���/ �5y1�'j- City Bus. Lic. # G� _7(o�f` <br />Address yOO�, g f�. f(/�1f �/'1 ��� f.c,V.v� (,t�%� _ �'�pU / Phone/Email Z - a% ! <br />TEIVAROT BUSIMESS NAME CONT/►CT FOR PERRAIT � <br />�/"GI!'NA' �/^ON� - /�'% SS�� �0�� c_ /��7G-�� C`'+��<< <-� �Gca` f"�1 <br />/ �/ <br />Phone/E-mail l�G'� /�7 C,f y�Ve�^Sn ��1� �.. <br />�BJIIo�INCs PoE1ifYIfT E6�P��C/�TIO� COfiET1�C'P PRICE OF ViIORtC �� 3? <br />Existing Use of Building <br />HEAT SOU <br />` 7��"i-C�/ <br />5l�a��e� <br />� . C-o beq <br />o e� <br />Proposed Use of Building � Gas Electric Other <br />Building type: _ Single Family _ Duplex _Tovunhouse _ Dllulti-Family _ Commercial <br />Type of project: _ New ,4ddition Remodel Repair T I Siqn Sprinkler Demolhtion Chanqe of Use <br />���GF�IPTOOIV O� WORK (additional space provided on the backJ : <br />��.��� ��� ,����a�.� �,�t ��� �x�rt�s, <br />vr R�wrn / �t 5 . a�u � wv�.�- r. l� <br />9 ���, �, � � �����s,�.s. <br />��c�������, ����s� ���������o� �����e�� ������ �P�������o� <br />of Project: � Wewr _�9dcJn _�lltereQion _Repair <br />Shouv Alumber # of �xtures <br />�� A/C - air handlin units <br />Forced air systems <br />�s Gas piping <br />_ Water heater <br />Gas ran e <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat um <br />Unit heater <br />Boiler <br />F2efrigeration <br />Woodstove <br />Ductin <br />�� Other � �''! � �. r <br />`�6F�1���� / �fl� �'����� ����El� <br />INumber of Heads <br />of Project: _Plew _�4ddn _Alteration _I2epair <br />Showi IVumber (#) oifzfures <br />I Toilet <br />Lavatory (wash <br />Shower <br />Kitchen sink 8 c <br />Dishwrasher <br />Clothes washer <br />Water heater <br />Sink (service/b� <br />Backflow orevei <br />Floor drain <br />Grease Yrap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this application and know ihe same to be true and correct. All provisions of laws and ordinances governing this type of work will be compl <br />wAh whether specfied herein or not. The granting of a permit does not presume to give authordy to violate or cancel [he provision of any other state or local law regulating consWction <br />That I am au o' by the o ner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />�� � <br />. � - � � � y /�� �z�.� ,� � �z� <br />mvuq �1�, aed �, nf Signa4ure Date (Revised 9/2014) ` <br />C <br />