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DU�LDDHGOvIiECN NIC ALIPLUPVIi BDNGISOGHiSPRMKLER9DEM0LMOMI <br /> CITY OF EVERETT PERMIT SER=ES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 w m.everetbAra.org <br /> SITmot.'�. <br /> PROPERTY TAX# E IT <br /> Al <br /> LEGAL for new construction: Short Plat/subdivision 5l��Lot No. � (attach copy of long legal description) <br /> OWNER ) 14 1�- Q�{ Phone/E-mail <br /> City/State/Zip rtLpJ �7�� Lf� <br /> Address � (� j�J :��� Q� O�� �/aV l�11`i Q(4,,L+, <br /> APPLICANT::—Owner _Ownter's Agent X1 lContracttor _Contractor's Agent _Tenant(must Provide a letter of consent from the owner to do work in the space) <br /> APP <br /> CONTRACTOR ) il, �'(!(1Gfl �fl•'JY'J��/f� 1' ��► State Lic.# fl, f� `11���r(,City Bus.Lic. <br /> Address ` E l ) :f i�I✓I ,�il.(f rf'°: Sin XI` J3id 1.li�Cl�� Phone/Email / 1i5� j 3 l(% <br /> 1 =9 I Of- - - CONTACT FOR PERMIT <br /> TENANT BUSINESS NAME <br /> Icy <br /> Phone/E-mail <br /> 00 <br /> HUgL�oOOMS UDERV/ Oil' ,PPLOCXTEOM CONTRACT PRICE OF WORK �� - <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Gas,-- Electric Other <br /> Proposed Use of Building <br /> Building type: _Single Family _Duplex Townhouse _Multi-Family _.Commercial <br /> Type of project New Addition Remodel Repair T.I. Sin_Sprinkler Demolition Chane of Use <br /> 7-E <br /> DESCRIPTION OF WORT((additional space provided on the back): <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 handlin units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&dis osal <br /> Gas ran a Dishwasher <br /> Clothes dryer Clothes washer <br /> Ran a 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 /> Sd)JF�ofHea�ds <br /> SYSTEM Other: <br /> NumbeOther: <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 workwill 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 m 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 /> Le 014 <br /> Owner/ uthorize Agent Sim ure Date ( ) <br /> it <br />