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06/29/2016 wED 16:07 FAx Fa�t water Heater �402/002 <br />- �'ERMIT APP�.ICAT�� I ���� -. <br />BUILDING/MECH,ANICA�,/PLU1111F31NG/�IGN/SPRINKLERlQEM�L,ITI�N <br />C1TY OF �VERETT PERMlT S�RVICES <br />3�200 Cedar St., EvArett, WA 98201 4,�5-257-58� 0 FAX 425�257-8857 www.everetlwa.org <br />SIT DD 3: �^ 1 P OPE TY TA N O PERMIT # <br />�v �� <br />LEGAL for new Conatructton: Short �'lat/subdlvlslon l,at No. (aK2Ch capy of long I�g�l descffptlon) <br />�W��� � U� I'hone/E-mall ��-%� <br />Address Clty/StdtelZlp � <br />� <br />APPLICANT: _ Owner _ OWner's qqent Cohtractor _ Contractor's Agent _, Tenent �m�o� pro�lde a letterarconean: rrom Ine awnerro ua work m ine ep�a�v� <br />CONTRACTOR � � � � '�- State Llc. # w� � �,.Clty gus- Lic_ <br />�'C-• <br />Address � �' I N �� �•/�UUI•l S' � � j,�'� . ! � PMonelEmail pri5 (�3 rVyl �-�S •�' ..� <br />T�NANT BUSINE AME CONTACT FOR PERMIT csi�C.�- <br />�� ��1�� <br />Phone/E-mal{ � � <br />BUILbING P�RMIT oPpL1CAT1oN CONTRqCT PRICE OF WORK L°'" <br />�xisting Usa of Bullding FIEAT <br />Proposed Use oP c7T f� Gaa Electrlc 'Qth�r <br />Building type: _ ��arrtily Duplox Townhou Multi-�amlly _ Commarcial <br />T e of ro'sct: New Addltlon Remod Re Ir T.I. SI n S rinkler DemaliEion • Chan e of Use <br />DESCF2IPTION OF WORK (add/tlonef spece provlded on tha ,backJ : <br />��� �r �� � �G ��- ���- <br />� <br />MECNA�IC�►L PERMI'f' /►PpLiCAT1�N PLUMBIN(i PERl1AIT �kPPLICAT101V <br />rype of Pro)eci; Naw _�qddn „Aileratfon �,Repalr iype vf Pro�act: �New �Addn Tqlteratlon _Repalr <br />5ho Number o�f/xtures Show Numbei of flxtureg <br />A✓C — air handlln units Tollet <br />Forced air s stems �athtub <br />�ce I In Lavato wash basln <br />ter heater Shower <br />Ga flre lace Kltch�n sink 8, dls osal <br />Gas en e Dlshwasher <br />Cloth dr �r Clvthas washer <br />�ian e aocf Water heater <br />�xhauef Slnk servic�/bar/mo /etc. <br />N�at u Backflow reventer inslde bld <br />Unit h fer Urfnal � <br />Boi r Drinkfn Fountain <br />�F oratlon Floor draln <br />oodstove <br />Ductin , Greeae+tra <br />Other RoaF drefns <br />Medical Gas <br />S R1N �R / SUVPRE3S10N YSTEM othar: <br />Number of HeAde ' Oiher, <br />1 herepy ceKl(y lftat I have read and axamfrted lhla abpNcatlon end knaw Nte same tp ba t�uA and ooRect qq pivVfabna of lawg y��Q orcl�hances gpvarning 1111e rype oFwork wfll bg Corrp <br />wl(h Wn�tY10r apealfled her81� or not. The gr8tt6�g of a Derml[ UOet �Ot preaume tp g�v0 aulharlty �p v101p(0 Or cencel Ihe p�pv�sbn ot eny other e�td or iocal isw regulatlne �pnatrValion <br />m 1 � dt11 Aut rized oy Ihe OwneroF t�le property to perforrn �hm work Forwhlc qpplfC�tfon le mey6 en6 1 Oamplywl�h �h0 Stete Contrecrore LeW 'Ig,Z7 RCW end 298.200a WAC, <br />Qw r/ utnorized Ago Slgnatur� Date <br />(Rev/sed 4/2076J <br />