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11/09/2016 WED 13: 09 FAX Fdbt water Hedter U002/004 <br /> 0OPERMIT' APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLE RIDE MOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425,257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRE95: O PROPEflTY TAX IT <br /> rD� ( © <br /> LEGAL for new Construction: Short Plat/subdlvlelon Lot No. attach co <br /> ( py of long legal description) <br /> OWNER �} I Phone/E-mall O <br /> Address �a, 1 <br /> V — S City/State/Zip <br /> APPLICANT: Owner _owner's Agent COntrHCtOr _Contractor's Agent Terrent(must provide a letterof coneent from Ina ownerig do work In the epeca) <br /> CONTRACTOR 1N1,1 L-'0 g City Bus. Lic-# <br /> Address <br /> kJ .. Phone/Email195 b 3 ✓Vl/"1�S -P� 4c <br /> E BUSINESS NA CONTACT FOR PERMIT <br /> Phone/E-mall � � � <br /> BUILDING PERMIY APPLICATION CONTRACT PRICE OF WORK <br /> 5xisting Use of Building EAT SOURCE. <br /> Proposed Use of <br /> as mectrlc Cthor <br /> Bullding type: Single rami _Duplex Townhouse Multi-Family Commercial <br /> Type of project, New Addition f3omod®I Be a r T.I. Sin S rinkler Demolition Chen e of Use <br /> DESCRIPTION OF WORK(addltlonal space provided an t ® ack)PAAA-A lJX U <br /> OAS � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project: _New_Addn ­Alteratlon_Rapolr <br /> Type of project; Newddn _Alteration Repair <br /> Shoal Number tb of fixtures <br /> ow umlber # of fixtures <br /> A/C—air handlln units Toilet <br /> Forced alr s stems Bathtub <br /> Gas i In <br /> Water heater avato wash bast <br /> Gas fire lace 'hower 1.11 <br /> Gas ran a chen sink,& s oral <br /> Clothes dryer DIS weshe <br /> R--hood Clot s cher <br /> EXhflLlst fan Wate eater <br /> HGatpurnp Si se Ice/bar/mo /etc. <br /> Unit heater ckflow eventer Inalde bld <br /> Boller Urinal <br /> Refrl oration Drinkln Fount <br /> Woodstove Floor drain <br /> Ductfn Greaawtre <br /> Roof dralns <br /> SP INIKLER / SUPP ION SYS M Medical Gas <br /> Other: <br /> Other: <br /> I hereby 001-tify that I havo rded*nd bxflmined thle apptloallon and know the®arse to ba true and celract.All Provislons of laws Nhd ordln-----governiariceang ng It l6 type of worst WIII be comp <br /> with whether epeolflad herein or not.Thp granting of ev Permit does not presume to glvv eufhot1ty to vtoiale or carlogl the proviblon of any other stale or local law regulotlhg oonalwotion <br /> That I am euthorl d b the owner of ihlg propeRy to perfor�1111-1w'-)rk fpr Which eppI1UE�Uon Ig made end t <br /> foomply Wlth the State ConVaotors Law 1g.a7 RCW and 290.200A WAC- <br /> Daterizod Agent Signature <br /> Date <br /> (Pov/sad <br />