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12/29/2016 WED 10: 45 FAX Fars+- water Heater 0005/005 <br /> . ERMIT APPLICATION <br /> BUILDING/MECHANICAL,/PLUMBING/SIG NISPRINKL.ER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., L"-veretf, WA 98201 425257-8810 FAX 425-257-8857 wvvw.everettwa.org <br /> SITE ADDRESS: xD f I U S - k PA PE TA Tp iR T# <br /> LEGAL for new conatrructlon: Short Plat/subdivision Lot No. (poach copy of long legal descrrptton) <br /> OWNER Mc Phone/E-mal! LIPS `", �1 ��5 <br /> Addreee rp S <br /> Cltyl9tat®/Zip <br /> APPLICANT;—Owner _Owner—,Agent Contractor w Contractor's Agent <br /> Tenant(must provftle a le tier of coneent from the owner to da work fn the apace) <br /> colvrPIACToR �( n - Stgte Llo. Wvi� T Ecclty eus. uc. <br /> Address (25 !`� �E ��'VUL! i_M 8�p C <br /> E BUSINE NA 1,,[A-- phonelEmall <br /> CONTACT FOR PERMIT <br /> Phon®/�-mall �(� L Cry 6r <br /> L3UIL_DING PERMIT APPLICATION CONTRACT PRICE OF WORD( <br /> Existing Use of Sullding 1-IEAT SOURCV: <br /> Proposed Use of Sullding `C Oas Electric Other <br /> 13ullding type; Single Family OL Duplex Town Multl-Family Commercial <br /> T e of ro PTI( New /addition aarnod I ell' �Re@ T.I. Sin_Sprinkler Demolition - Chane of Use <br /> DESCRIPTION OF WORK{additional space provided oh the bao1�: <br /> f4AANO <br /> MECHANICAL, PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: __,_Now–_lAddn _Alteration`Rupalr Typo of Proja � W Addn AftoratrRopalr <br /> SNOW Number # — — on of fixtures _ <br /> Show Nu er # of flxfuras <br /> A/C–air t,andlln units <br /> Forced airTo ts stems Totb <br /> i­ Both <br /> Wafer he <br /> Das 1 eater Lavato wash basin Gas floe Shower lace <br /> Gas ran e Kitchen s k& 1 oSol <br /> Clothes dryer Dlshwash <br /> Range hood Clothes wa r <br /> FXhaust fan Water hea <br /> Heat um Sink ser ce/ r/mo /etc. <br /> Unit heater Backfl revs ter Inside bid <br /> Boiler Urin <br /> Re frl eratfun Dr kin Fountain <br /> Woodstove 0 drain <br /> nuotln Crel3se'tra <br /> Other Roof drains <br /> SPRIN PPRESSION S TEM Medical Gas <br /> Other: <br /> Number of <br /> Other, <br /> I hereby pertlry that I hetvv riled and 13xal>1lned thla appllceilon And know the earne to bm true and coiract.All provl6lana of lawG end ordlnehcea governing thle type of Work will be comp <br /> with whether epeclflea herein or nat.the granting of a permit does not presume to give aulhority to vlolpt©or cancel the provlblon of ahy other rlletlo or local lewr®gulating conatnrcllar, <br /> Thal I er ¢ruthorrgptl by the owner of lhl9 property to pe forrn Iris work oor which gppllcetlon 19 metlo end I comply with the State ContrActora Law'16,27 f7CW and 286,200A'NAC, <br /> Ownor/ hoar gent Slg aturm <br /> bete <br /> (Revised 4/2015J <br />