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02/20/2017 MON 14: 04 FAX FaAt water Heater 4002/005 <br /> 'ERMIT APPLICATK <br /> BL]ILDING/MECHANIICAL/PL.UM13ING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St„ Evorett, WA 98201 425-257-8810 FAX 4.25-257-8857 Wvuw,evorettwa,org <br /> SITE ADDRESS: PROPERTY TAX <br /> 11 ✓ b LLJ ooz <br /> LEGAL For new construction: Short Plat/sohdivlslon Lot No. <br /> C <br /> OWNER (attach copy of long lege,description) <br /> Phone/E-mail — 3 <br /> Address L4 SE CRY/State/Zlp 8 <br /> APPLICANT_Owner Qwnar'u Agent Y,Contractor Contractor's Agent —Tengrlt(muet provide a leder crcnneynl from the crmer to do work In lne apace) <br /> CONTRACTOR " � I State Uc,# U <br /> lty Bus. Llc. ` <br /> �PVU 1c- <br /> Addreso orJ��t 3 ✓Z'I 1"I�� 4�'TLl <br /> TENANT91NESS NAM <br /> ECONTACT FOR pFRMI7 <br /> rhone/E-mall L <br /> 13UII-DING PERMIT APPLICATION CONTRACT PRICE OF WORK d <br /> Existing USc of Suilding AT SOURCE: <br /> Proposed Use l[d1 <br /> Osts Electric Other <br /> Building type. Single Famll DuplexTown Multi-Fernli Commercial <br /> a mmercial <br /> Type of project New Addition Ramod I Re T.1. Sf n 5 rinkfer Demolition Chane of Use <br /> DESCRIPTION OF WORK(addivanwspace provided an the back): <br /> g4AIVI-15 <br /> T <br /> MECHANICAL PERMIT APPLICATION LUNUBIING PERMIT APPLICATION <br /> Type of ProJoct: _New_Adde Altarotfon_Repair TYPa of ProJac, Naw clan <br /> sfiow Number, tp of fixture$ �4iteratlon_Repair <br /> Show Alumb of fixtures <br /> A/C,air 1--l-g units <br /> Forced airs sToll <br /> Toll <br /> Gat I In Lavato waeh basin <br /> Water heater 5howar <br /> Gas 0-1— <br /> Gas range Kltchon si & Is oaal <br /> Clothes dryer Dishwashe <br /> Renria hood Clothee wag r <br /> Exhaust fan Water heater <br /> Haat pumpSink servlc /mq left. <br /> Unit heater Backflow pfeventVir Inside bid <br /> Boller Urinal <br /> Refrl eratlon Drin 1 9 1=ountaln <br /> Woodstove F or drain <br /> Ducting reaae,`tre <br /> Other Roof drains <br /> SPRINKL R PRIESSION TEM Medical Gas <br /> Other: <br /> Number of Hoa Other: <br /> hereby mhiry that I hvlvo rAed and examlnmd Chia 8ppllcellan And know the same to be true end correct.All provhlona of Iaw$and ordinenoea governing Ihl6 type Of <br /> with whether spaGinad herein or not,The granting of a permit cloe3 not presume to glv®authorlly work w111 he Co np <br /> to vloletb or ean0al the provlSbn of any other stet®or IOCeI raw reguiciing conairuotiorl <br /> that I em cut riz9d by the own®r of t la property 10 perform Iho Work for whish epplf0aflon Is made and <br /> r Comply with the Stato Contractors law 10 Z7 RCw and Z90.200A WAC. <br /> 7wh®r/quCh Izod Ag ht Signal We <br /> Date <br /> (Revlsod 412016) <br />