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BULDD NCGME—CHAMICAUpI U vMi BANG/SOGNiSPR0 KL ER/DD LPvIi OL�T�OV9 <br /> CITY OF EVERETT PERMUT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> -------------- <br /> SITE ADDRI=Cc' PROPERTY TAX# MIt V/ r O <br /> 4,1-' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. d(attach copy of long legal description) <br /> OWNER� � 1 ��- Phone/E-mail IF, �7EJ Lrc) <br /> i Ci /State/zi ; �{ 4 g�C� <br /> Address ��� 5 ��' to P �J� r t, <br /> APPLICANT:—Owner _Owner's Agent T Contractor _Contractor's Agent _Tenant(must provide a leve consent from the owner to do work inthespace) <br /> } ' ,, �,S,t �lld�G) State Lic.# i716 �p� `t�. `� City Bus.Lic. <br /> CONTRACTOR iftl 'I'CtG( �t't✓•)Y�.lit� C <br /> 1`�(Gtr�i)s_ 6l i t.f f E�°: I toiYn a J,),li\///'� Phone/Email <br /> Address k � rl r <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 'l,� SPS <br /> MUMS PERRM'T QPPLDCL%T00M CONTRACT PRICE OF WORK � �� 9i __J <br /> �� — <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 S rinkler Demolition Chan a of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 5a OF� <br /> ET1 67iq <br /> Vii IE rC'Gz1QI 9Q%L PC=D�G�Ii 9-r QPPLOCQTDOG�1 PLMGt11i C�0G�10 PERMOT QPPLDC�Q�DOO I� <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 handlinq units Toilet <br /> Forced airs stems Bathtub <br /> Gas i in Lavatory wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Dishwasher <br /> Gas range <br /> Clothes d er Clothes washer <br /> Ran a hood Water heater <br /> Exhaust fan Sink(service/barlmo letc.) <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refricieration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> KLER/ SUPPRESSUGH 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 compl <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 m4authodzy the owf 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 /> 1 Date (Revised 9/20j4) <br /> Owner/ Agent Si'y ure <br /> t �` <br />