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WERMIT P UC A Moo <br /> BE, UL fl,G/Mr--CHAT ICTAL/PLUM B ING/SIGN/SPRI KNE R/o EMOLDTi 8OM <br /> CITY OF EVERE T PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SIIEADDRESS: PROPERTYTA)C# 71 mxlu:�bi D I�a�zc �N �2 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E ma _ - <br /> ,Address %/ ' ����/v City/State/Zip <br /> APPLICANT:_Owner —Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR (le-A-1, A 6. State Lic.#i ce �` (��ZC)T-' City Bus. Lic. CUI 755 <br /> �'t <br /> Address 2-1 Zo 6r'{C i� (C Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> VeM '15�tw C 4.05) ;2---31/1Lt <br /> Phone/E-mail j <br /> 31-U1L®p��6 E' Gbl�t' pPi(=pCAgl®�� -- CONTRACT PRICE OF WORK - -_-- <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 /> Type of project: —New _Addition _Remodel._Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERP,111 ' APPLICATION PLUMOUNG PERMIT APP[ QCATUO NI-- --- <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> I Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler j Drinking Fountain _ <br /> Refrigeration Floor drain <br /> Woodstove _ Grease trap <br /> Ducting Roof drains <br /> Other _ j Medical Gas <br /> SPRINKLER / SIJJPPk��SSIGN SYSTEM - � j 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 governing this type of work will be complied <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 I am authorized by the owner of th D perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> OwnerfAuthorized Agent Signature Date (Revised 3/2093) <br />