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pERNMY APPUCLaMN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE DRF <br /> PROPERTY TAX# P I 1 <br /> AD� �:_ �� � i � � Dnp � <br /> LEGALfornew construction: Short Platisubdivision r IC Lot No.K6J(attach copy of long legal description) <br /> 0WNER � 11�• 0 Y®� . Phone/E-mailL�'i <br /> Address V2.0 S>���.�( <br /> 011V-CA X100 City/State/Zip C477Ciq <br /> APPLICANT:_Owner _Owner's Agent . !Contractor --Contractor's Agent ,_Tenant(must provide a letter of ent from the ownerto,do/work initth—pace <br /> CONTRACTOR I, �f' IJL{ �((,�)i?Jilirr F'3'l. �6) State Lic.# � � ?�`� 47 City Bus.Lic.#v07—'0 5 <br /> E, /� ✓ v ��„ { L r� <br /> L �t I`�{�(f�d) .l ✓ i.i f � S i��i ta% i i6 1,litlll�� Phone/Email <br /> Address � � % n __ t i <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> C�MDI�DD I�'!O f�fs�G�/rVI4 ApP(>=06A1TIOO Nnl CONTRACT PRICE OF WORK ' <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Proposed Use of Building Gas_ Electric_ other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Tvpe of ro'ect: New Addition Remodel Repair T.1. Sin_Sprinkler Demolition Chan a of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> //nuts o <br /> MEHAMOCAL PERUIR u' APDL OCG IrBOf� PE6��lli U5( API�L�OC�QT I©I� <br /> C <br /> Type of Project: Now 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 airstems Bathtub <br /> s <br /> Lavatory wash basin) <br /> Gas i in <br /> Shower <br /> Water heater <br /> Kitchen sink&disposal <br /> Gas fireplace <br /> a Dishwasher <br /> Gas ran <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Backflow preventer <br /> Heat pump <br /> Urinal <br /> Unit heater <br /> Boiler DrinkingFountain <br /> Boiler <br /> Floor drain <br /> Refrigtrap <br /> Woodstove Grease Roof drains <br /> Ducting <br /> Medical Gas <br /> Other <br /> / SUPPRIESSOGN SYSTEM 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 /> Th m authoitz 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 /> Revised 9/201.l 4,L, <br /> Owner/ uthorize Agent Sil�n ure Date <br /> �, l I ?r <br />