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� o <br /> 0 <br /> 0 0 0 � Q <br /> pC�G3V�v�► �� appL�OC�Ia`��O[� <br /> �M��D�f�C��G�v�iC�C��IQ��C�Q�9p�,M�lii ���1C�O��C����pG����G�I�C��D��v�i0o(���i ���� <br />�, ���� �� ������r� ������ ����u��� <br />' 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 �nn�vw.everettwa.org <br /> SITEADDR�cc' PROPERTYTAX# P T � r ` V <br /> G' � � <br /> �r1 ?_� . ��''. ' � _��c� <br /> LEGAL for new construction: Short Plat/subdivision��� ���"��I�..�..��--Lot No��(,�� �attach copy of long legai description) <br /> OWNER����d,��d�..� ���o_'L.I�1��. �"9���"A•a Phone/E-mall �-�e,�. �jt}`� '�.��'(;;C� <br /> ,,.., -, <br /> t =� 1', � CitylState/ZiP �Vp�r�`L L{', �;/�li�'' ���b��1�� <br /> Address 9��1.1 �ahJ ?�� ��3�A�,��h'�.\� '�'(��JE� <br /> APPLICANT' Owner Ov✓ner's Agent �.�Contractor Contractor's Agent _Ten2nt(m�sc Pro�-�d�a ie�ter of�o�,5ent rrom c'��oo��er co do work�n me 5pzoe> <br /> 6 i;•K �f� -;! /' ('�?,� 'i' 9'�'��a'I�I6'"3G) State Lic.# �,�I�.�:E�,�����-:�Ji�,`°p�E��� City Bus. Lic.# �"l� <br /> CONTt�ACTOR }'�llt.,t°'�_L1 I�13 l�%%�..� r . <br /> Y �' f r� <br /> Address C �� 9`���i��i'!);i;�� 6 i��.r!I,�i.i 61`?�r-�: ��6n��G�11a�e''1..fi�.f'/(1"r Phone/Emall If!'�S ,j�� 5 �d L1+�% <br /> TENAiVT BUSIf�ESS iVAME CONTAC i FOR PERMIT <br /> �. � r.E' q? p I C,� " t'-j 1:Q✓`� <br /> ���`"`��--_,� Phone/E-mail ��'�,� �' .�"�ES �-� � <br /> C�M�dDOf,��C� f�C�G`��r�i 04 /apP�O�La I��OO R9 CONTRACT P1210E OF WORK �� �r7 ������ �C� <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Proposed Use of Building Gas_ Electric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Muiti-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 /> DESCRIPTIOfU OF WOF2frt(additional space provided on the back): <br /> � ' /� ) ' �'�.-���✓ �%��''1 <br /> �� a � � _ ��;�-�.- i /��f�,-�--� ������,���" `-�� , <br /> � ��� � � . � <br /> ������o��� ����o� a���o�a�o�� �����o�� ����o� ����o�a�o��, <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixfures <br /> A/C—air handling units Toilet <br /> Forced air s stems Bathtub <br /> Gas ipin Lavato wash basin) <br /> Water heater Shower <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 Drinkinc Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Other Medical Gas <br /> �f����IG����/ SIP�IPlf3���8��1 �SY�`�°!�(1i4� 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 Iaws and ordinances governing this type of work will be compl <br /> with whether specified 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 /> That�9''am authonzeA by the ow�fr of this property to perform the work for which application is made and I comply with the Stale Contractors Lavd 1827 RCW and 296.200A WAC. <br /> 1 , j' <br /> ,� � ! ����� 8� �� -�� � �� �,; <br /> � � Date (Revised 9/2014) \ <br /> Owner/�horize Agent SiL,�n �fure � ) <br /> ' � <br /> ;` .,, <br />