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1����v�i 0`� l,�l�pf����`���� <br /> �������������a�e�a�/°�������I�O������e�����r����������� <br /> c��� �� ������� �����������c�s <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDRF�f�� ��� �t- r� J PROPERTYTAX# MIT�� r � � <br /> ,r .� �� , , ,, � <br /> LEGAL for new construction: Short PlaUsubdivision� r eL � Lot No.���C'iattach copy of long legal description) <br /> '? - ��� � �' �` ! � - Phone/E-mail `��'L�% `"(r7 `, ��S'�.iU <br /> OWNER����1.��1"�C �'�-�-1�i i�-�. +�G�� l��" <br /> Address �'�Ll �'v`� �\1������0�,���A�� '��J4.i City/State/Zip r-tl�'�;-`L�3. ���n. C:��7 j U;� <br /> APPLICANT: Owner Owner's Agent �Contractor _Contractor'S AgBflt _T@Il21lt(must provide a letter of consent from the owner lo do work in the space) <br /> " �'' , •� -`! � / 1'�, %J;��"�y�; State Lic.# '�� t,!"y�� Cr,�; C; Fi�� Cit Bus.Lic.# ��u <br /> cor�-rRacroR �,�.�o-�r��.Cr,e.; ��(l��zn���'i��c�, r l���d � �� �°��..,��E�-,�:�J����-� �� v <br /> � �.> � ,� ��! �7 <br /> Address � �"`_. ��I Gi��rl;�;�t 5�✓+.�,�i:i i�`�t�-�: �a;��inG`,''f7�����1.iiSf,�"�� Phone/Email 1 �y5 ,�`� S �I tJ�% <br /> TENAiVT BUSINESS PVAME CONTACT FOR PERMIT <br /> � �''" ""' � C„! �' i!'�n � <br /> � Phone/E-mail '��`�,,E� " .'�p"p E5 � �� +��� <br /> �1����IN� 6�E�R�E411`�' ��6�P G���'9�R�1 COfVTRACT PRICE OF WORK �� � 3�� �� ��-�-� <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 /> DESCRIPTIOtV OF WOR�C(additional space provided on the back): <br /> � 6 p � ���:��� i t'�i <br /> 1- _ � �'�wl� y�. ��'�/�/ - ���� ��1 <br /> !/�`��,/C � � � ��::���- � , ��" <br /> ��C������� �����-� ����.o���e�� �����a�� �����T ����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 i in 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 Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SP f�IGKLE�/ SUPPRESSIOId SY�T�BIli Other: <br /> �^ Number of Heads Other: <br /> I ereby certi hat I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be compl <br /> wi wheth 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�11 m authorize�l by the owf��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 296.200A WAC. <br /> r f t' <br /> t '!� '�� � �e'`.."�,�'�r' �� ( ��V_ / �� �,f <br /> � <br /> � � <br /> Owner/�horize Agent Sig�ure ' Date (Revised 9 <br /> - �� <br /> � ���� �� � � • <br /> � <br />