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. 05/18/2017 THv 14: ia FAx Fa�t water Heater f�004/006 <br /> ��� <br /> PERMIT APPLICATI�N <br /> . BUILDINa/M�CWR�IfCAL I pLUMBINQ/SIGN!SF'R(NKLER/DCNIOl1'1'lON <br /> CI'fY OF CVERETT PERMIT SHRVECCS <br /> • 3200 GEbAFt S712��'f,�VERETT,WeA 98209 <br /> (P)42G-267-80i0 � FAX 425�257-8837 �(E)evaraftapsC�e��rellwa.gov� www.everetlwe.gov/permfla � <br /> Blue or Bigck Ink Oni �tesse) Pl�OJQC1�'SlT�tNFORM{1TIOr+II <br /> PFtOJ�GT 9ITE ADDRESS: � S 5 � PROPERTY TA}C#: D � <br /> LEGAL Por naw construc4lon snort PfeUsubtllvlslon Lot Na (aifa�h oapy oF lang Iagal deserlptlan) <br /> CONTACT INFORMA7iON <br /> OWNER NAME: ' D � TENAtd7 NAME IP Cammerclal): <br /> OWN�R IUlAiL1AtG APtif��SS: eme�r � � �,�i <br /> cm 9YATE ain � <br /> OWN�R PHON�: ' OWNER EMAIL: –�— <br /> CONTRqC70Ft NAM�� '� S �� T <br /> CONTRACTOR ADDR�S9: srae�r � � � <br /> CrtY � � STA7E zlr � <br /> CONTRACTOR PNONE: �-'�p�s CONTR�ICTOR�MAIL: ��VY� I�T S �U.� -Iv' , <br /> � CONTRACT012�ICEIVS��(R�QUIRED),�� �'i"-� �"�' � C17Y OF 6V�R�TT BU91NE88 LiCeNse#(REqUIRED): � 1�3 <br /> PRlMARY CONTACT: C�OWN�R CON'1'�2ACTOR 0 OTHER(P[eaea SpaCff}I) <br /> cON7Ac7 NAM�; ���� cOr1TaCT�t-�vN�: �� <br /> I�"T� CQNTACT 6MAIL: ���-� ' � .�-�, �'j(�/j/) <br /> �Uyza��O p��Ml'r'APPLICATIaN <br /> � Existfn Uee of Sulldi� : Contract Price of Work:$ � <br /> pro osed Use of Bulldln : I�eet Source: I�Gas letlrlc DOther � <br /> Bulltlin : ❑SFI�-Detaehed ❑SFR-All�ched �Du lex ufll-�amll �of Units• ❑Commerclal �Industrlal <br /> "F e of Pro ect: C�I�aw dAdd►tlon ClRemodel R� air �T,1. ❑si n ❑s rinkler QDemolltlon ❑Change of Use <br /> DESCRIPTION' 0�WORK� � �� \�A �� ` ���p�/ �� n�� ' <br /> ��r ► p�� �} ��. ,�1..+�(',��G �6 ��v <br /> .�i� <br /> A390CIATED�UI1171NG P�RMIT� ff e Ilcebl�: <br /> 1411�4CHANIOAi P�RMiT APPLICATION PLUMBIN� P�RMIT APP�.�CA#T10�1 <br /> 7ype of ProJoct� _Naw` Addre „_,Alteretlon �,Rapelr Typp of projecf: _New �ddn �41tAratien �taNalr � <br /> F��°� !./at nf Fl�furea FnrturAg Ust of Flx s �°� �fat of Flxfurea #oP Llst of flxtures <br /> Flxturea Flxturas I <br /> Al Units Heat Pu Toilet Backflow Pfsventer Inelde 81d <br /> � orced Alr S tems UN eai�r Bathtub Urinal i <br /> Gas PI n iler La�rato Wesh Basin Drinkln FOulltaln <br /> Water Waatsr Refrl erallon Showar Floor Dreln ; <br /> �ea Flre I�ce Waod 5fove Kitchgn Slnk&Dls oeal �rease Tra i <br /> Gaa R�n a Ductln Dishwaeher RoOf Dralne � <br /> thea 17 er Ho a Iher: clothes Waanar. Medical Gas � <br /> Ran Water W��ter Other: � <br /> Ekhaust Fan Slnk 5ervlce/SadMo etc. OthOt: <br /> Sl��tIN 1�9�I0 M � <br /> emlcal or W ,of Heade I <br /> ACKNOWLEDOEML�NT;l hav�►eWewed fhle epp!lcallon and conldm�he I+,fomullan contafrtad neraRt Is lrue and cvrreeG Wak done pursuent ro thla permlt mcrs�tomply wlfh � <br /> curren!federel,arete,entl�oaal lew.TBe qrentlaq o1 e permll an6�suMoriaes eAarvved work arrd no uavwaons Ihorermm.Dev/atlons musf 7r�t pe aulhaked In wrlNng/rom fhe � <br /> Bu!!ding OXbleJ beMre being eufhorhad unde�rany cdcumsferrc�.1 a�m N,a ownar,or!am authafzed by the owner of fhla propeNy fo per/orm tNe work for whloh apDNcaffon►s ma4e, <br /> end!comply Wi/A lRY S161v ContA9Cfo1's Lo W!9.2y RCW dnd 2AQ?AOA WAC � <br /> Clly of Everetl ONl01�1 UBO O�ly ' <br /> ��1�- 1�- p�� �r S �o� ? <br /> , <br /> Own uthorze Ag �Signature Date Re se ao <br /> I <br />