Laserfiche WebLink
pC��v�i �� l�pp�0��`��Oo �J <br /> �MOI���I�C���v�iCC�I�/a��C� �,�dpi�M�iv ��(�C����C���9�p����G:Cl�C��DI�G�v�iOoi����0�� <br /> �9�1f �� ��i��G�,`�� G�C���9`� ��f�@6V�[�� <br /> 3200 Cedar St., Everetf, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDR���' PROPERTYTA)(# �T�� r ( r O � <br /> Ir! =I _ �:C �' - , I `l '� _ � � <br /> LEGAL for new construction: Short PlaUsubdivision���E�- 6���In� Lot No.�v L1 �attach copy of long legal description) <br /> � � . <br /> OWf\IER�3L�9.1�b``-� rf�'�-'L,1�1�. ��:�l��_ Phone/E-mail `'-�'LE� fj'!J _`3 ��.�'r.if�� _ <br /> t ? .a \,` ��� ; '`i City/State/ZiP F,IV'�,�2,Li', ��n !'����1'r� <br /> Address 9'�(oJ �•�!'�,} ...�� �Y��4.���-� V '�(�.J4�� <br /> APPLICANT:_Owner _Owner's Agent l� Contractor _Contractor's Agent _Tenant(m�5�pro�-�de a ien�r or co�5em r�om�he owner to do v;ork in the space) <br /> COfVTt�ACTOR t-t(,��.�%���f�Lil If{(•7,+�'�Jl%i�;� f'1���;���y`�G� State Lic.# ;�t�.,���/�:';��'�'?-�"B Z rfd� City Bus.Lic.� U <br /> J �� � �! <br /> � n � ��( —_ �? r� n���a l�6���1..I����/l1"r Phone/Email tf�y5 ,�`�'� � �P�Je.% <br /> Address U ���� �`16G(f�d)�;� fl r�,�i,s6 �-' : �r � <br /> TENAiVT BUSINESS NAME CONTAC`I FOR t'ERMIT <br /> 3�r?E� ,�P ��,� '� i.�r.�'���;'� . . <br /> `--�-_,�_ Phone/E-mail '''V �.�_) ' .?'�E� �- �`.�'`,.� <br /> L���dDOL�'IC� (�C�f�G��i�� LaPPdOC�Q 1��0�'I COfVSRACT P�210E OF WOf?K �� �s') �� �' �� — <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Gas Electric Other <br /> Proposed Use of Building — — <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> T e of ro'ect: New Addition Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTIOftI OF WOt2F�(additional space provided on the back): <br /> ; � �' _ �, /� L� � ��'�� - ,��'2.-������ ��� <br /> �/'�;�� � a �%�� �.- � o;�f�-�-- �� , <br /> d, � �' <br /> V1fVI��l�1L�Ir�10(�/,�N� f�[���t�V�`P Qf��d�C�Q4��[�I f�L�NJfi�fd[��G�� P[�[i�f�IliO�' laf�PL��Q�r'��M <br /> Type of Project: _New_Addn _Alferation_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> AIC-air handling units Toilet <br /> Forced air s stems Bathtub <br /> Lavato wash basin) <br /> Gas ipin Shower <br /> Water heater <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher ' <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Other Medical Gas <br /> ����ft�DFr4�lEQ�/ SID��l��S�D�I�H ��Y�T�f�� Other: <br /> !� � Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances goveming this type of workwill be compl <br /> with whether specifed herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> Th�t 1''am authonze�9 by the ow�4r of this property to perform the work forwhich application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br /> r <br /> �� � � ( ������ �� l ��� � ' �-f <br /> Date (Revised 9/2014) <br /> Owner/�horize Agent Si,E7�n ure � ] <br /> I � <br />