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06/1�/2016 TUE 9:�9 FAX Fa�t Wdtpr HpdtOY (��QQ/��5 <br />��r�nni-r a���rc,����� C�a�� � �'� ._ <br />BUILpING/MECHAN�C�AL/PLUIVIBING/SIGN/SPRINKLEI�/pEMOLITI+�N <br />CITY OF EVERETT PERIVIIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-$810 Fl�X 425-257-8657 www.everettwa.org <br />��J �- � p-y� � � PROPE <br />L �S�J o�� <br />for now construCtlan: Short Plpt/eubdfvislai� <br />� <br />No. (attach Copy of long legal deaCrlptfon) <br />��U ��! 1S�"7(n� <br />-�3 <br />�r°6b � � V �/ VV Cltylstatel�fp �j <br />3 <br />PL,IC�qNT: ____„ Owner _ Owner's Agent Contrp�tor � Contrqctor's ligent � Tenant �mue� pro�kia a ieaer ol conaen� rrem 1nm a,.�e� w uo worrc m me spacs� <br />�NTRAGTOR � - ��- State Llc. #' �A��AJ �- t� � Clfy Bus. Lic. <br />Iress ��� � � �� /� ���' �4 e l I �,,��,J /�/� <br />"i^�UV� � Ul� Phone/Emell �a� �i? 3�0 ! �S `"1 �%✓rM 1�( u"'l'�1$-}t,{ <br />� ..���� .�. <br />BUI[.pIN� PERM�T APP�.lCATION <br />�' �i i`�F t/� <br />PRrce oF WORK <br />Existing Uee of Buliding AT SOURC�' <br />Propased Use o Gas Electrlc OthOr <br />Building type: Single Famil � Duplex,�7ownh Muftl�Family ` Commercial <br />7 e of ro ect: New Addition Remodel Re a� T.I. Si n S rinkler Dernolitfon • Chan a of Use <br />L)ESCRIPTION OP WpRK (addltlona�spec� prov�aer� on e�ck) � <br />���.� °�-�� � �i C� .. � , r�,.,�.e�' <br />� � <br />MECHAh11C,AL PER111�1T APPL�CqT10N <br />of ProJect: _New�Addn �q�toratlon �Rap�lr Typa � <br />E <br />_rvv—aii �iq�IWlf1�jUIlICO <br />�orced alr systems <br />C3as ! In �� <br />Watar heaEer <br />G�s fire lece <br />Gas ran e <br />Clothes dr er <br />Ran e hood <br />Exhaustfan <br />Heat um <br />Unit heatar <br />Boller <br />ReFrigeration <br />W oodetove <br />Ductlnq � <br />Oth�r ^ <br />UPPItESS10 <br />Num r!c <br />G PERMIT �1PQI.�CAT10 <br />,�4ddn _Alteratlun _Rs��alr <br />mber # oY►►xturas <br />�•Ot19� <br />athtub <br />L vato� wash ba <br />Sh er <br />Kltch sink dis ooeal <br />Dishwa <br />Clothe sher <br />Wa heat <br />k servlce r/ma /etc. <br />ackflow reve er inslde bld <br />Urinal � <br />Drinkfn �ounrain <br />�(oor drain <br />prease �tra <br />Roof drains <br />Medfcal Gas <br />Othor: <br />Other: <br />I hbreby aetNEy that I have lead ena 9x�lmined Ih(s appllc$��oh ahd know the eamm to be lrue sntl correct. All provlE(ons oF lewa antl P��nehcae governing Ihls rype of Worlc wNl 6e GOIT�p <br />wlth whether epoclnetl harein or nof. The 8ronting o� a pgYmit daea nof prea�me to glve aulhorlty la vlolete or �gncol the provlalpn ol dny alhvr etste or Iocal law regulaling cona�rudtlon <br />That � em au�ho�iz9d by lhe owner p� lhla property io perform lhe work fpr yyhloh appllcatl0n iE made end 1 c0iflply wllh the 3tat9 ConlrActors Law �10.27 RCV�1 And 296.2000, wmC. <br />w er/ thoriz� e, 91gn- re — I ��� <br />Date (Revfsed �l/2015) <br />