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O9/01/2�16 THU 13:02 FAx Fa�t water Heater �0�3/�Oa <br />... ��.n�i� A���icA�r��� 1 ���3°I . <br />BUILDIN�/MEC�lANNCAL/pLU1N�BIN�G/SIGN/SPRMIVf{LER/Ia��UIQLITIaN <br />cirv ow �v�R�Tr a�R�nir s�Rv�cE� <br />3200 Cedar St., �vere#t, WA 98201 425-257,881d 1=AX 425-257-8£357 ww�ni.everettwa.org <br />ITE ADDf,2�55: <br />i � <br />� <br />T <br />�L. for new corl9t�uctlon: Short Plat/eubdfvlslon �ot No. (attacli C4�y of long lo�pl desarfpEfon) <br />ER � I Q Phone/E-m�ll %�' .� � ds <br />�d��sg I C 1 �J D <br />PPLICANT: ,�„_ Owner ,� Ownor's ,vc ont <br />CONTRACTOI� _fi'� <br />4ddreas � ���� N <br />Cfty/5tatelZfp � � <br />Contractor _ Contrector'a A,gent T@I79flt (muetprovlde e IeNeroPconeent from Ihm aWnerlo do warkln Ihn Spac <br />� �� Sta#e Lic. # - �/UIRJ }- � Clty Bus_ Lic_ <br />S �� � (I /� <br />�,�J - Phane/Emall �� (� 3 ✓Yl I-f-� �,M <br />CON'iACT FOt� PERMI7 �ti ��.. � <br />��rt`-1 3��'�4-tliE / - <br />BUML[)ING PERMIT APPL,ICOY`IQN <br />�xlsting Us� of BuUdfng � �' r`' <br />Propoead Use vF �ullding____ IV L f� <br />Bullding typo: ^ Singfe Famfly , Duplex _ <br />CON1'RACT Pf�ICE OF WpI�K _ '� I� S <br />Commerclal <br />H EAT <br />- _ •_ --•• �•�• ����� � ����n�tl� uemonuon • cnan e ofUse <br />DESCIZ�PTION O� WORK (addltlonsl spece provlded orr thg beck): <br />, <br />������ �� �.- ��. � , � <br />� , �� �� <br />MECFi4�lICqL pERMIT APPLIC4T�01►r <br />of ProJect: �,Naw _Addn �AlteraElon �aeA�lr , <br />G <br />Wa <br />Qas <br />SPRIN <br />-a <br />S'YST� <br />PkUMb�N6 PEItMIT AI'PLICATION <br />Type of prvJect; �New_�Addn �AlterHtlon�Repalr <br />SHow NumGer � o�f/xfurss <br />Toflet <br />_ .,, __ Bethiub � " <br />Shower <br />Kttchen sink & d1: <br />Dlehwasher� <br />Clothos washer <br />Weter heater <br />Slnk (servlcelbar/ <br />Backflow �reventE <br />Urfna! • <br />Drfnking Founteln <br />Ffoor drain � <br />Greas� �trap �� <br />RooP dralns �' <br />Medlcal Gas <br />Other <br />Number of — -- <br />Other: <br />� hereby Qenlfythat f heve r�ad and pxamined (h�g appllcailori Rhd know the 9ame tp be tfUe end carrect, All provlalona ur laWe end ord�nancea governing thle type of work wlll be �omp <br />wlth whethor aDeclfied heroln or no6 The granlfn� af e perml! daee not proeUme [p glvg eulhary(y to vlolete pr cencgl the provl6lon o( dny olher Btdle or �ocel faw r�pulaling cong��cflan <br />Thet I en §sulhorizsd 6y tltig �ner Of p�lo propaKy �o DerfoYm Ehe wonc fOr �yhich pppqcatlon le made and I �omply wpFt tha State C;Ontractore Lyiw 18.27 RCW and 296,200A wAC. <br />- � � / \ � � 1 / � ''� / r f / � I .. <br />(Ravlsed 4/2015) <br />