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02/22/2416 MOx 12:07 FAx Fa�t water Heater �009/V03 <br />� � PERMIT' APPLICA'i�V .�35s� <br />BUILDING/MEChIANICAL/PLUM�ING/SIGN/SP�INKLER/IaEIUIOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., �verett, WA 9B201 d2�-257-6810 F,qX �25-257-8857 wvwv.everettwa.org <br />- � � � � i Wv u —� � (i (_'� U�J <br />LE(3AI. for now conslructloh; Short Plet/subdlvlslon Lot No. (attqch copy of long fegpl deecrlptfan) <br />OWNER Phone/�-malf � O �" 3 �� <br />Address I I � CltylState/ZIp . � g� � <br />APPLICANI': _, Owner _ p�,,ner's Ag�r1C � Contracror � ContractOr's Agent _ 7enant (muei pro��de a �etter of conaent �rom �he ownerio ao vrork �n chespace) <br />CONTRACTOR � � �� State �ic. #� �/Li�t1 � Cify Bus. Lic. <br />Address � �' � IV �l.� `t"f—�11� �C-- Q U� � <br />S �/LQ' �AJ � Phone/Emal( a���3 � 1-� ,� <br />!aN'f BUSINE AME CONTACT FOR PERMIT ��, <br />------�-- ��f K� ►,� <br />Phone/E-ma11 � �,. <br />�UILDINa PERMIT APPl.ICA71�N CONTRA,CT PRICE OF WORK <br />Existing Uae of Building N�AT SOURCE: <br />Propased Use o� <br />Gas �IeclNc Other <br />6ullclfng type Single Famil ` Duplex�Townh Multi-Famify _ Commerelal <br />T e of ro ect: ew Addit+on Remode a air T.I. SI n S rinkler Demoliiion Chan e Qf Usa <br />D�SCRIPTION O� WORK �addrtJvrrai s,o�cs p„ov�ded on e eck) ; <br />`1���' �'-�-/ r� � � C�-- . � ��r � �-� <br />� <br />MEGHANIC4L PER,MIT APP�IC4TION PLUMBIN6 PERMIT pppLICATION <br />TYpe vf Profect: �New �ddn 'Altoratlon _Ropalr Type of ProJ t: _hiaw _�tldn _qlteratlon _Repplr - <br />Show Number # ef f/xturea Show Nurirber or!lx�urea <br />A/C — alr hendl�n unfta Tollet <br />Forced alr e stems 6athfub <br />Gas i In L�vato wash basln <br />Water heater Shower <br />Gas flre lac� chen sink & dla os <br />Ga� ran v Dls washer <br />Clothes dr er Cloth washe <br />Ran e hood Water h t <br />�xhauet rgr, Sink ser /bar/mo /etc. <br />Haat um Back re nter inslde bld <br />Unit heater Ur' I <br />13oller rinkin Fountaln <br />Refri eration Floor drain <br />Woodstove Greas� tra <br />Ductln Roof drains <br />Other Medical Gas <br />SP INKLER / SVPPR�SSION S other: <br />, <br />N� ea s Oiher: <br />I hprmby cerHFy thel I ha�e read snd eKalrined lhle eppllCalloh and know the g�me to be true end correct. All proVtslons oF lawa �end ordlnancea go�ernlnQ thls type cyt wp�k will be oomp <br />Wlttt whather epeCi�ep I��raln or no�. The granling ol a ��rmlt doaa not pr0suma in glve euthorlly lo vlolote or esncel the prvvlslon of any olnar 9t�la or Iocel law r�gulmUnq aanstruC�lon <br />That � am aul orl2gU by �he awner of �nls praperiy lo perfarm Ihe wark �vr wnlch appllce�lOn Is me�e gnd 1 Gomply wlth !he 5101s Conlrectora ��w 19-27 RCW a�tl 286,200A WAC. <br />�-��-i� <br />�'N r ut orizad �A�ent 91 ura Dale s.� <br />� � �d (Rsvlsed 4/201BJ <br />� <br />