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Nov 09 2016 08;49AM Washinaton <br />8663757454 <br />1 <br />PE�RMIT APPLiCATION � <br />BUiLDIN MECHANIGA PLUMBINGlSIGNlSPRiNKLER/DEMULITION <br />CITY OF EYERETT PERM�T SERVtCES <br />3200 Cedar Si., Everett, WA 982�1 d25-257-8810 �AX 425-257-8857 www,everettvva.org � <br />iADDRE8S; l+f i f „ .� - " ----_----- <br />1 �V D <br />tor newconstruction: Short Plat/subdivision Lat No. <br />(atiach copy of iong lega! deScriptior�) <br />� ��►�' _ Owner's Agent <br />contrRaczoR <br />� � <br />BUILDiNG PERMIT APPL)CATION <br />rnoneie-man —�' G7 �� y �^iJ_y <br />� <br />CityiState/Zip � ��ii�` t�l.J /'t' <br />� Ol <br />fi9�if _ TEn21lt (musl prov{Ce a tanerol consent from tlm pwne� tp Qe H.p� 3n Ihe <br />;GlT.rJ Sfdte Lic. # (�f/f�l-� f-�f� <br />(�,. L� 0.J � � Phone/Email Qp <br />co�r�c FOR p�wu��r <br />��L. C C�# l.c.1 <br />Phone/E-mail � �j -� <br />CONTRACT PWCE OF W012K <br />Existing Use of Build'ing � � (/`� <br />PrapaSed Use^o�f� ildin <br />Building type: �• 7. Sringle Pamiiy , Duplex_Tawnhouse _MulEi-Famil <br />—f'"— Y .._ Con <br />Ty� of project: New Add(qon Remodef Renair T I Si�, <br />DESCRIPTION OF WORK (addifional space provided on the backJ ; <br />�� �� � �P��-� � �� <br />� <br />MECHAN4CA� PERMIT APPL1CATtON <br />of Project: _�Naw_Addn _�►�teratlon _Repair <br />Gas <br />f <br />es d <br />HEAT <br />aus. Lic. # O �,� <br />� U1�.lUlt.ftllQ.0 <br />�,�n�c� . uemoulion Ghanqe of Use <br />W WI / <br />� �� �.�� �S� <br />PLUMBlNG PERMIT APPLICATION <br />Of Projecl: �Naw�Addn _Aiteratlon_�peir <br />Show Ncunber {#j of t}xtu�es <br />_. Tailet � <br />�� <br />Medical Gas <br />Other: <br />& <br />��e�bY ��1�'Y �hat � have read arta examined this appiicef;on ane know the same to be Lue and correct, Alt provls7ons ot iaws and ordinances ovemin ihis <br />u+l ther spacifiad herain ornot. The prantiig ot a petmft doe o1 presume to pive �ut� fl 9 bPe alwork wB! �a comp! <br />at 1 aulAorhed by 1he ownsrof Ihls �Y �o vio�ltr or cancel tha provlaion af sny afher st@te or local larr nayulaBng construclfon <br />� D�+ lo perform tne rk for whkh a pGca'on Is made and I comA�Y w+lh the Slate Contradors Lav� 1 g,27 f2CW gnd ypg 2ppA y,�qC <br />/�-��� <br />Q IA thorized Agent Signat <br />Date <br />(Revised 9/2014) <br />z <br />