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� � ���' �, [�pL a�l,�`�D � <br />�� �. —, <br />��������i����������������������s������a����������ao���� <br />��,�� O� ������� ��R��� ���v���� <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />TE ADDRESS: <br />� 3D2 Q v <br />PROPERTY TA)( #t <br />004�, ! �l 4��d Z�o 2 <br />L�GAL, for new construction: Short Plat/subdivision Lot No, (attach copy of 16ng legal description) <br />OWNER Q(� J� i�0� EC�6-y[..�'iQ15 (�L C Phone/Gmail 2,j � 3D Tj —gp00 <br />Address P �� �% 2i � City/5tate/Zip EUGfIL�i Wi� g� � 3 <br />AFPLICANT: Owner _ Owner's Agent �„ Contractor _ Contractor's Agent _ Tenant �mu5t provida a leu�r ot�onsonifrom ine owner �o a� <br />C�NTRACTOR }�V�����C'���-�`� <<iZ-AcTi <br />Address ��'"�v r�[�1,� �,1�--�,� �.�1 <br />-�-�.��� Er2 44� <br />BUI�.DING PERMIT APPLICATION <br />Stafe L'Ic, #��� ���G��' l City Sus. L.ic. <br />� � Q�!'J ( Phone/Email � �� .- 'Z�2 � � � �/ <br />r°1a��Rk� �-5�n�u�A ��orM <br />melE-mail <br />CONTRACT PRICE OF WORK <br />C�— <br />�2y -25 2-�/l� <br />X�O <br />Exlsting Use of Bullding �_ �l�T i'��'�%'�"�� HEAT SOURCE: <br />Rroposed Use of Building [�n 1,'�i��'� Gas�_ Electric_ Other <br />Building type; ,_Single Family _ Duplex_Townhouse _ Multi-Family 7C Commercial <br />Type of project: ._ New Addition _ Remodel � Repair _ T.I. _ Sign _Sprinkler _Dem�lition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the 6ack): <br />(Z,� t2 2 '�iR.a cl� 'rc.v � r�f� v✓J �rc�`�- �� ��c�`' � << N S,�w�� Ga,��.d� � �f��c.._ �o �P <br />��S(116 is� g'� �l b V FXJ'[I ti1(, � Co �[�S . �A �' �QU( �M dri�T � N 5 T4'l (� /NS �/!d �UGc.Di ✓� <br />1 <br />AP <br />Type of Project: _New_Addn _Alteration,�Repair <br />Show Numb er (#) of fixtures <br />A/C — air handling units <br />,Z Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes drye� <br />Range hood <br />� Exhaust fan <br />Heat pump <br />f Unit heater <br />� Boiler <br />{ Refrigerafion <br />� Woodstove <br />� Ducting <br />� Other <br />SI91�IP�' G�L.�� / ��JI�6��I��S0��9 ��(�'� <br />Number of Heads <br />IT APP <br />ofProject: ^New_Addn ,_,Alteration,_Repair <br />Show Number (#) of fixfures <br />r <br />sher <br />washer <br />nter (inside <br />llnnai <br />Drinking Fountairt <br />Flvor drain <br />Grease frap <br />Roof drains � <br />Medlcal Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined ihis appllcation and know the same to be irue and correct. All provisions of laws and ordinances governing this lype of work will be complied <br />wiih whelher specified herein or not, The granting of a permit does not presume to give authority io violate or cancel ihe provision of any other staie or local law regulating conslruction <br />That I am a ihorized by the owner of this property to perform the work for which application is made and I comply with the State Contracto�s Law 1 B27 RCW and 296.2DOA WAC. <br />� v� <br />OvPR2ifAuthorized ent Signature ate (Revlsed 4/2015) <br />