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46/09/2016 WED 12: 41 FAX Fast water Heater 0003/003 <br /> SPERMIT APPLICATUA <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cadar St., Everett, WA 98201 425-257-6810 FAX 425-257-8857 www.everettwa.org <br /> ;SITE ADIJRESS: l�=M/r <br /> LEGAL for now oonbtructlon: Snort Plat/subdivision Lot No. (attach copy of long legal dsscriptlon) <br /> OWNER ` fPgAPhone/E-mail Jt✓ <br /> Address C D City/State/Zip " <br /> APPLICANT: Owner Owner's Agent Contractor _Cvntractor'u Agent Tennnt(muetprovlde a ratter ofconvent hom Ina owner to do work In the space) <br /> CONTRACTOR State Lic-# w� Cit Bus. Llc. <br /> Address C � 1 N �� � l/UL� phone/Small a5 �3 OVl <br /> NANT BUSINES AME CONTACT FOR PERMIT [ta ✓. <br /> Phone/E-mail (� t/ <br /> BUILDING PERMIT APPLICATION ]CONTRACT PRICE OF WORK <br /> Existing Use of 13uilding HRAT _ <br /> Proposed Use of BDas I®ctric Ther <br /> Building type: Ingle Fa ly —Duplex Mufti-Family Commercial <br /> T e of Prot' New Addition Remoda Re alr T.I. Sin -Sprinkler Demolition • Chane of Use <br /> D ESCRIPTION OF WORK(additional space provided on the eck): <br /> MECHANICAL PERMIT APPLICATIO11111 PLUMBING PERMIT APPLICATION <br /> Type of p Naw----Addn _Altaretton_Rapalr Type of Protect: _New—Addn _Alteration Ropalr <br /> Sho Numbor # o111xturas Show Number # of fJxtures T <br /> A1C–air handlin units Toilet <br /> Forced airs stems Bathtub <br /> Nan i In Lavato wash basin <br /> ter heater Shower <br /> Gas re lace Kitchen sink&disposal <br /> Gas r e Dishwasher <br /> Clothes r r Clothes washer <br /> Rane d Water heater <br /> Ex tat fa Sink(service lbar/mo letc. <br /> at um Backflow reventer inside bld <br /> Unit heater Urinal <br /> Boller Drlhkin Fountain <br /> R®fri eratlort Floor drain <br /> Woodstove Grease"tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION,SYSTEM Other: <br /> Number of Heade Other; <br /> I hereby certiry that I have read and examined this amilcatlon and know the same to be true and correct-All provlalons of laws and ordinances Aoverhing this type of work WWI be comp <br /> with whether specified herein or not.The granttng of 0 perm([00615 not presume to give aulhorrty to violate or cancel tht9 provlelon or any othor slate or local law regulating aanslructron <br /> 'Cha tam authorfzed by the owner of thio prpperty to perform the work forwhlch application le mad0 and I comply with the slate Contrector9 Law 10.27 RCW and 296.200A WAC. <br /> f ' I <br /> Own dtharized Aga Slgnature Date (Revised 412015) <br />