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02/22/2016 MON iz:07 FAx Famt water xeater <br />�0p2/003 <br />�P�RMIi APPLICATI�J � ��1�'1� <br />BUILDIN�G/iVI�CHANICAL/PLUMBING/�IGN/SPRINKt�ER/DEMOLIT'ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 Q.25-257-8810 �AK 4�,25-257-8�57 www.everettwa.org <br />�aess: <br />n. i �,7�+ <br /># <br />�s <br />LEGAL for naw cpn9tructlon� Short plat/subdivlslon Lot No. (attach copy of (Ong lega{ descrlptlon) <br />OWN�Fi 1 V 1� ' � �� Phone/�-mail � D �� y�� <br />PLfCANT; _ Owner ,�, Owner's Agent <br />ONTRACTOR <br />ldress � ��'� <br />Contractor ____ Contractor's Agent _ Tonant (mustprov�de e letferarcn�sanl irom ine owner ro ao work rn �ne sp,�oa� <br />Bu1l,p�N(3 PERIIIfIT ,APpLICATION <br />Existing Use of Bullding <br />St9te LiC # �w �- <br />�� r <br />�,�J � Phone/�mail o <br />CONTACT FDR PE�tMIT <br />.��rt`,l K� L� <br />ONTRACT PRICE OF WOi2K <br />� �.Cit Bus. Lic. # � <br />(v,3 �r✓v► �-��S �t'i: <br />lR-f�V <br />� � w <br />� <br />—•�- - ,� <br />HEAT SOURC�: <br />Proposed Use I Gas Elecfric Other <br />Building typ '�Single Fa _ Duplex_Townhou Multl-Family `Comrnercial <br />T a of ro ect: Now Additlon Fi�modef Re a� T.I. Si n S rinkler Demolftlon Chan e of Use <br />D�SCI=IPTIO�d OF WORK (additlon�l spece Provlded on the back) _ <br />��� � �.� ( t�. C-�e._ � �,�(�3.�e�- �..Q.r.�►-�- <br />� <br />MECN4NICAL P�RMIT 4PPL,ICAT10 <br />1'ype vf ProJect: _Ncw �ddn �j�ltaratlon �Rapalr <br />Show Numbar � ofTlx(ures <br />A/C — air handlln units <br />Forced alr s slems <br />Gas pfping <br />_.. � Water he�ter � <br />L <br />Kanqehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />n <br />/SUPPRESS <br />er af Meada <br />P4UMBING PER�VIIT APPLICATIQN <br />of Praject: ,WNaw �qddn �ItOratlon _F�epalr <br />, 5huw NurnbAr (#�) of f/xtures <br />hwas <br />Slnk <br />Floor draln <br />Grease trap <br />Roof cirains <br />Medlcal .Gas <br />Other: <br />Other: <br />ter (fnslde bl <br />I heireby oeRffy thet I heve resq mnd examfnad thig dppilvatlon entl know [he gatne to be lrug Bttd correcf. All prpvlEloha oF lawe and or�lnallcos doverning Ihle rypa of work wf11 be comp <br />Wlth whetnor apeclfled hereln Or not, Th� granting oF a permlt doee nol pY�Sume lo g{va aulhorlly lo vialata or cancel lhe provlelon o� any oiher atete or lacal I�w f0gulatlnp aanshuc�lpn <br />Tnat 1�m du orized by the o ner of t proper{y lo verforrtt the wprk fo� Whlch eppllcanon �a made end I camply wllh lhe Slete Co�t+'ACtOrs Law 18.27 RCw end 296.20QA WAC. <br />-�2-- I lo <br />Ownerl u orized AgAnC S gnature Date (Revfsed 4/2095) <br />