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BU8LMNG/VVvgiC�C HAM DCALIP LU vii •VHUM HGSMN KLER/DEMiOUTMA <br /> CITY OF EVERETT PERI@ T SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDRFcc• PROPERTY TAX# <br /> of 5-- :'q�'�' �5+ Q� � <br /> 11 <br /> LEGAL for new construction: Short Plat/subdivision 1/►C & Lot Nokf j- (attach copy of long legal description) <br /> OWNER Phone/E-mail LfJ `j t7`, z�'Oo <br /> AddressL� Sv.1 ._ \`t Sxq -Ni JE�i City/State/Zip t/°'�; Wil', F%� Ci oL- <br /> APPLICANT:—Owner Owner's Agent h !Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> pAddress <br /> R l ( /' Ljl �(,'j %/i t ['1' �l y�C'� State Lic.# �i, ifs]?L 9�7r t S City Bus.Lic. <br /> IGlfi ) ;I / L iii 6 d� fs i1Y �1QV�3(;h A1'1 Phone/Email '�S INESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> 3 lUj OL o pMs p;ERM!17 APPLOCAVROm 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.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORM(additional space provided on the back): <br /> O ECHAMCAL PFERG141iOT APPLOCA798M --- PLUMBING PE[�6�U T APPLOC�A`F UCH <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 piping Lavatory wash basin) <br /> Water heater Shower <br /> Gas fireplace 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 /> Refri erationFloor drain <br /> Woodstove a Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRIMIKLER/ SUPPRESSO®M SY37EM Other: <br /> 1 Number of Heads L Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.Ali 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 /> T7 authy 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 /> l.® <br /> Owner/r orize-ff Agent Si ure Date IRP+' <br />