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pCRNET l>PPUCAMN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> PROPERTY TAX# <br /> SIT�EaADDRF-Q-Q• <br /> I"I - <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No.W iattach copy of long legal description) <br /> (` Phone/E-mail q2E, %)-5 zgocj <br /> OWNER S(X,k ' 1!i 1�• 1 <br /> `i <br /> City/State/Zip <br /> Address � 1� !9� \�� �V b'd V� ' <br /> APPLICANT:_Owner —Owner's Agent Contractor _ Contractor's Agent _Tenant(must provide a le. of consent from the owner to do work in the space) <br /> State Lic. City Bus.Lic.# 2� <br /> CONTRACTOR jil/� ; Gflllrl //�� ( e �j g <br /> v '! <br /> E� n ? r 1r Phone/Email <br /> /�q 3 q ,7 <br /> Address U K 1`�(C, r) :f 6dr _Lif si�UVtai^r`Ji.�(�l.l��11�7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> t� <br /> Phone/E-mail ' S'L n3 5 <br /> 13UHLDD RMS PERP II i7 L,1PPL OC LUrROO N CONTRACT PRICE OF WORK <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Proposed Use of Building Gas_ Electric_ Other— <br /> Proposed <br /> Building type: _Single Family _-Duplex Townhouse —Multi-Family Commercial <br /> Type ofproject: New Addition RemodelRe air T.I. Sin_Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> G <br /> MFC HARIOCCAL PERGV�10`u' APPLHC�ATO01,� P(�N�G�11iL Ol�lO PC [ DIni05P APPI>=OGATO®�l. <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 airs stems Bathtub <br /> Gas pipin Lavatory wash basin) <br /> Water heater Shower <br /> Gas fire lace 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 Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPREMI LER/ SUPPRESSDOR'I SYS u'IEM 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 comps <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 /> TThm authodz by the owof this properly 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 9/2 <br /> A thorize Agent Sii ure Date <br />