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09/04/2016 THU 13: 19 FAX Fact Water Heater fr�002/00,1 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8557 www.everettwa.org <br /> FLEGAL <br /> AD S: VK- P V y � �� PROPERTY A {3 PERMIT <br /> i� 3 boo l ��oo ; �for new conetructlort Short Plat/Buhdfvlslon Lot No. (attach copy of long legal descriptlon) <br /> ER + 7�v1'I <br /> y� Phone/E-maU <br /> Address VLK~ {� City/Stdta/zip <br /> j <br /> /APPLICANT:_Own®r Oyvngr'9 Agent Contractor _Contractor's Agent _Tenant(mustUmvlde a I,rtterofconsent ream(ha owner do work In the pace) <br /> CONTRACTOR f8Sr J ���Lcl <br /> State Lic.# Clt Bus. <br /> Address L � I �>GI� //-)/Ut'l C �1�� ( <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT � .. <br /> Phone/E-mall <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 6}" <br /> Exlatlnq Use of BUllding <br /> n� HEAT E; <br /> Proposed Use of Building <br /> Gas Elecirfc Other <br /> - <br /> Type <br /> type: ____5ingfe Family -�DUplex,__.Townhou Commercial <br /> of ro ect: New Addition Rvmod Re al T.I. Sl n S rinkler Demolition Chen ® of Use <br /> DESCRIPTION OF WORK(addltlenal sp®ce provided 077 the back): <br /> Ck- <br /> MECHANICAL PERMIT APPLICATIO <br /> PLUMBING PERMIT APPLICATION <br /> Type of project: `Naw_Addn _Alteration_Repair Typa of Projact: New Addn ,Alteration Ftepafr <br /> umber # of flxturas � J` <br /> A/ <br /> 3hot,'Num6ar of fixtures C— r hendlfn unite <br /> Forced a •s stemToilet s Bathtub <br /> Gas I In <br /> Water huIn Lavato wash bnsln <br /> Gas fire lac® Shower <br /> Oas ran e Kitchensink&disposal <br /> Clothes dr or Dlshwasher <br /> Ran e hood Clothes washer <br /> Exhaust fa Water heater <br /> H u Sink svrvlce/bar/mo /etc. <br /> Unit he or Backflow proventer 0nolde bid <br /> BON Urinai <br /> Ref eratlon Drinking Fountain <br /> W odatova Floor drain <br /> uctln Greas®=tea <br /> Other <br /> Roof drains SP INK R / SUPPRESSION SYST Medical Gas <br /> Other: <br /> Number of Heeds <br /> Other: <br /> I hereby gerlify that I have read and examined Ihls aoOcatldn and know Ole same to be true and correct.All provfalona of Iowa and ordinances governing thla <br /> with whethor epeclrled rterein or not,The gram(Ing of a permlt does not presume to give authority to violate or cancel the rovlblon of ren orhor g g type of work will he comp <br /> That In ttUtharlZe4 by the o nee of th propBrty io perrorm the work for which appllcatlon 19 made and I Comply with the Slate t y State or local law regulating con3trucllon <br /> I y ortlraatore L*W 18.27 RCw and 296,200A}NAC. <br /> / � I V/ <br /> Own®r thorized Agent 9 tlnatur® pate <br /> (Pevlsed 412015) <br />