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EMMMMECHANICA PLMVv�B�NGIS�G A/SGS'RDNKLER/DEPvIOL1 T0O�A <br /> CITY OF EVERETTl PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDR1=c-Q' PROPERTYTAX# MI�#� �W <br /> iq I- <br /> - - 8fti EL S <br /> LEGAL for new construction: Short Plat/subdivision n Lot No.j4J (attach copy of long legal description) <br /> OWNER S(!Cj T� 1 1��- � '` �> Phone/E-mail '`�G� ,r <br /> Address �'�(-f ! v> ��? i-i V �4 111✓i City/State/Zip tf2�i L�", w1a, Cq �(�`7 <br /> ECONTRACTOR <br /> LICANT:_Owner _Owner's Agent n Contractor _Contractor's Agent _Tenant(must provide aletterotc ent from the ownerto do work in the space) <br /> ) �I /' •tl ,�l1I %ii� �► il State Lic.# ,Ll, t� ?•`�� � City Bus.Lic.# �� <br /> o v �p� <br /> E (, % 6il:lL (.(f ' S✓i(,Vidi^f�8 i��j,Iiyf1/n? Phone/Email <br /> Address V �_ ��IC rd��, <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> `.� Phone/E-mail �S [E5 �' <br /> CM�dDo 9,N�1� PCG�I4/�V�4 Q�p�p�p�p�� 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 ofproject: New Addition Remodel Repair T.I. Sin_Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> U <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 /> AIC-air handlina unitsToilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran a Dishwasher <br /> Clothes drVer Clothes washer <br /> Ran a hood Water heater <br /> Exhaust fan Sink service/bar/mo /etc.) <br /> Backflow preventer <br /> Heat Pump <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigieration W Floor drain <br /> Woodstove Grease tra <br /> DuctingRoof drains <br /> Other Medical Gas <br /> 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 comp! <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 /> JThm authoriz by the ow 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 /> a\ 1 -.- / [ La Date (Revised 9/20 <br /> Owner/�horize Agent Sign ure �� <br /> / tel <br />