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������� ����������� <br /> ��9�����/V���C�Q�����/p��f�i �1��/�9��/���I�E����/�[����9����� <br /> c��v o� �������' ����i�s���oc�� <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDR�cc• � ,, PROPERTYTAX# IT �/�I/��1 <br /> � �� ?_! �' ��i� �' � .�l � � � �.�J <br /> LEGAL for new construction: Short PlaVsubdivision� �Il. 6l Lot No�� �attach copy of long legal description) <br /> C�z i� <br /> OWNER_.)����d.�7'"�� '�%L.1��i`,W. `��.���I`�'�k"'. Phone/E-mail �'�'G.c% ��6f}`a '�,4''(_'.?�� <br /> Address 9����' ��� ���l���j��.A�,���� ���J��� City/State/Zip �t���`�2.�-�_e �r_�• C�(�j(,�zw6 <br /> APPLI CANT: O��rner Owner's Agent �Contractor _Contractor's Agent _Tenant�m�5c Pro��ae a iener or co�5e�c rrom cne owr,�r to ao��:o�k m ma SPa�e� <br /> - - i <br /> COfVTRACTOR r��!_�%,��'(l,�Gi� ��,1,•J/��'��/%�li s'1��`-}�";'l�d'��j State Lic.# �,��,,1;;�;�li;,"-�"p� raf``� City Bus.Lic.# �S��V <br /> J `, ,y <br /> Address � �"` y�if�if�'!)��;� i�✓�.:L, �i�i 5 Y' �ra: ?;!�U r'��`i!1 d.`�b'1,fitl;��r Phone/Email Jj��� ,j� S �!C��% <br /> TENAiVT BUSII�ESS NAME COIVTACT FOR PERMIT <br /> �'"`"'�--.� Phone/E-mail '=� ��E� '" :�'V.� J ���ti;��"�.f <br /> I��JJ9��96�J� GA��FZ�iI`�' ,��fF�L���`�B�G� COfVTRACT PRICE OF INORK � Gl ��A �� �C� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <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 /> DESCRIPTIOfV OF WORFf(additional space provided on the back): <br /> ; r f ' _ � _/? �; � �'�� - f�`�--,����� ���� <br /> ��'��� � , s ��:,�-�.- � /���1� � (�� <br /> ���������� ����o� ����o���o�� �����'�� ������ ��������o�� <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Idumber(#)of fixtures <br /> A/C—air handlin 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/mo /etc.) <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPEZ96�bS1_EF$/ SlDP�9ZESS10P1 ��57'E9V1 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 work will be compl <br /> with whether specified herein or not.The granting of a permit does not presume to give authonty to violate or cancel the provision of any other state or local law regulating construction <br /> Th�t l'am authorize�l by the owP`�r of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> Gt 4�� <br /> 1 ��� I � t� V` [ ``.,��- � �I �� - <br /> Owner/�horize Agent Sign�ure Date (Revised 912014) �`� <br /> , 1 � <br />