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PERNIi F APPUCATMH <br /> BUJ LDDONGi IECH ° N�CAL/P LUMBo MG/SIGH/SPF,,',DIMKLGR/DEQ vgiOLOT�O�I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDRRcc• PROPERTY TA>C# PE T _ D <br /> LEGAL for new construction: Short Plat/subdivision yff 61 Lot No.)�b (attach copy of long legal description) <br /> ' <br /> 4Phone/E-rnailOWNER9� <br /> Address o �vO y ��?�� 1�,��1��/��I ���14r�' Cityl <br /> 6State/Zip �v��;2�I r vela <br /> APPLICANT: Owner Owner's Agent X Contractor —Contractor's Agent -Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTORil /'CL�Lfii i/'(�11Jj1/i� fflI1 fy�L) StateLic.# / City Bus.Lic.# <br /> Addressj(�tf ) ;� Phone/Email 1�1i5r J"t S�7 �7 l 0() <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail' <br /> BUILDING l�CEsl�'RAR if LAPPL0CAT0GM:::: CONTRACT PRICE OF WORK �� �� k� <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_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> PLMMBUMS PIERME7 AEFErPLUCATEGH J <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 drver Clothes washer <br /> Range hood Water heater <br /> _ Exhaust fan Sink service/bar/mo /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 /> i �ROG�II KLER/ SUPPEkEESSION SYS`l7IEM 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 v <br /> Th m authl 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 /> Owner/ uthorize Agent Sin ure Date (Revised 9/2014) ¢ <br />