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u i� lIU fl YY �[l � G=� �7 I� ��1 ``�G=11 Il ���� <br />��8��6h��I��C�C�� �nC�Q�O'� �M�1i � ��� �G�SSOC�G`��SSG������� ��D�6��is�ill�►���D�G`� <br />�i��r �� ��a���u � ����A� ����a��� <br />3200 Cedar St.; Everett, WA 98201 425-257-8810 FAX �25-257-8857 www.everefiwa.org <br />SI i � At7D{2�SS: <br />L�GAL for nev,r consfruction: Short Plat/subd <br />OWRILR ,�'T. ��'!/1/i`�C /1:'i L-�= <br />Address ��%'� Z� <br />/-�E'PLICANT: _ Owner _ <br />CONYt�AC i OF� �y�J�%d�C�� <br />Address �..r �� <br />TENAi�l�' BUSINESS MAfL4E <br />Owner's Agent <br />P RO P 6 RiY iA)( # <br />PERiL�I i <br />J <br />Lof No. (attach copy of long legal description) <br />G'LL- Phone/E-mail v� i <br />� t � City/5tate/Zip !.L,���7�.� , L� t � , ��� e�i� G C -�� � _ <br />—� <br />COfIfI'aCfOf _ C011f�aCfOf�S AC�EIIf _ T01l8t1f {must providz a lelter of consentfrom lhe owne� lo do work fn Ihe space) <br />�-iF�-'r C� �i fr Siaie Lic. �# (d��;(��<�` C�' �"2..� p` City Bus. Lic. �# 1� �7`� ��� <br />� f��.���1 J�j2 �_3 d iFG <br />��9�,���1� 6���E1fV0ii �aE'�'�D�Q'�QOO C�1 <br />Phone/Email _ _ <br />CONI"ACi �OR PGRMIT <br />i�t�.d�i <S�F�t� � ����) ��a� �fJ�f <br />Phone/E-mail !;i>i�ar��_D'�`�i�')C�r�G�.� <br />E'FICE OF WOR4< <br />Existing Use of Building HCAT SOURCE: <br />Proposed Use oi Building Gas� Electric_ Other <br />Building fype: _ Single Family _ Duplex,_.Townhouse _ Mulii-Family _ Commercial <br />Type of projecf: New _ Addition �Remodel ._ Repair_ T.I. _ Sign _Sprinkler �Demolition_Change of Use <br />D��CRI��101�1 OF UVOi2�C (additiona! space provided on the back) : .., - J,� - <br />�F5 � l_.�- l l�-A r l�- � � L� l'v�/i�- ( ��`� {� �: .��. �. 7�v�c �'�! .%c:. <br />��,x �"y�Z..tr i'U%L:=`L��' �:e �_ <br />6YiY�M�If96"�tl�Q'l��Y IiL'-�tl�l�Y�� 4-`"S���III-�G1 H 6��c1 <br />Type of Projecf: _New_Addn _AlferaYion _Repair <br />ShowNumber(d�) offixfures <br />� A/C — �ir handling unifs <br />� Forced air sysfems <br />� ! Gas pipiny <br />� Water heafer <br />� Gas fireplace <br />� Gasiange <br />� Cloth�s dryer <br />C Range hood <br />? _ � �xhaust fan <br />Heaf pumr� <br />� Unit heater <br />� 13oiler _- <br />� Woodstove <br />� Ducting <br />� O�her __ <br />�PL�96�' if���� / ��JG'PG����9 o L� �il��i ���i <br />� Number of Heads <br />�'��A�d6�6��� �'��3V�1�� ���'�����`�O��l <br />Type of ProjecY: _New_Addn _Alteration _Repair <br />ShowNumber(#) offixfures <br />� l oilet <br />� Bafhtub <br />I Lavaiorv fwash basin) <br />Shower <br />f<itchen sin{< & disposal <br />Dish�vasher <br />Clothes washer <br />Water heater <br />Sink (service/bai/mop/e <br />Bacl<flow preventer <br />Urinal <br />Drinl<ing Founfain <br />Flooi' drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Othei: <br />I hereby certify tf�at I have read and examined Ihis application and know the sante io be true and co«zct. All provisions of laws and ordinances goveming ihis type of work will be complied <br />vdith wheiher speciiied f�erein or not. The granling of a peririit does not presume to. give authorify to violate or cancel the provision of �ny oiher state or local faw regi4��(ing construction <br />�hat I am auihori ed by the owner of t's-�rop�riy to perform the work r'orv��hich application is made and I comply with ihe State Contractors Law 18.27 RCW and 29G200A VVAC. <br />i� � �_ <br />,�� ����� <br />; i ;�� —� � <br />' .-�-v �. -� �� --1�. <br />Owner/Authorized Agenf Signature Date (Revised 3/2013J <br />