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08/i2/2pi6 FRI 8: a3 FAx a25 z52 1666 CM Heating f�002/09i <br /> PERMIT APpLICATIO <br /> BUILDING�ECHANICAL / PLUMBING /SIGN / PRINKLER ! DEMOLITION <br /> CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR 6TR�ET, EVERETT,WA 8B2p1 <br /> (p)426-287-8810 � FAX 426-267-9867 �(�)evereifape(�evereUwe.�ov� www,everettwa.gov/permlts <br /> Bt�;�;.oW,B �ctk In�.+��ily.Pl��is� � ' PI�OJ�GT�SITC�IIyFQRMATl,��I'� <br /> PROJECT 91T�ADDRESB: �� � � �,, PROPERTY TAX#: Ov��� <br /> LECiAL}or neW Con9lYUotion: 9hort PlaUsubdlvlalon __ No. (att�ch copy of long legal desorlptlon) <br /> � ' � �,�, . C�IN'M'��C'r;MNF,QRN14TlON' � . • � , � <br /> OWNER NAME: � ENANT NAME If Commercl�l : ■ (� � <br /> QWNER MAILINd ADpRES8: sTReer 1`��`} `�� � <br /> c�rv '��,..�i sTnTe z�� U� 1 d� <br /> OWNER PHONE: � � OWNER EMAIL; <br /> CQNTRAC7'OFi NAME� <br /> CONTRACTOR ADDRESS: eTREET � <br /> CIiY 9TATE �• ZH� {��� <br /> CONTRACTOR PHONE: �O CONTRACTOR EMAIL: C`� � ` , <br /> CONTRACTOR LICENSE#(REQUIRED): � ��, GTY OF EVERETT BLISIN�$$LIC�NSE��REQUIRL : a <br /> PRIMARY CONTACT: ❑ OWNER NTRACTOR Q OTN�R(Pleese SpecEfy) <br /> CON7ACY NAM�; CONTACT PHO�VE; �� <br /> rn��ff 1 I — ���` CONTACT EMA�L: <br /> " ' � ' � ��: ' ' ' ,.��fUrL Nl��RLR{{AIT',APPI���ATIQN� � " � � <br /> Cxletln Uae of Bulldln Contracr Price of Work; �? <br /> I'ro osed Use of Bulldln ; Heal Source: ❑Gas lectrlc ther <br /> Buildln T e: ❑SFR-Delached ❑3FR-Aitached ❑Du lex ulti-Famll -#of Unite: -�✓ � ❑Commerelal �Indusfrlal <br /> T pe of Pro oct: �New ddltlon ❑Remodel ❑Rep�lr ' ❑ .I, ❑SI n �S rinkler ❑Demolltlon ❑Chen e of U�9 <br /> D�SCRIPTION pF WORK: <br /> r���.�, ��� d�l��s ►�� . �-��.� <br /> � �'�� �� <br /> A880CIATED BUILDING PERMI'f# If a Ilcable : <br /> �. ME�WA.�fICA ,PERMIT',�►pP�.I,C11�IbN � � ' 'PI;r1�4ABlI!���PERIV�MT APPLICATIQN <br /> Type of ProJoct: Naw _ Addn _q�teratlon Ropalr 7ype of ProJ�ct: Naw _Addn Alterallon Repalr <br /> #of ��=t of Ffxfu�ma #oi #of p o� <br /> FJxturas Flxtur�a ��at of Flxtuna ��x���s Ll�t of Flx[urea L18t ol F/xtures <br /> F(xlur�s <br /> A/C–Alr Handlin Unita Haat Pum Tollet Backflow Preventer Inslde Bfd <br /> Forced Alr S 9tems Unit He2ter Bathlub Urinel <br /> Gas PI En Bollor Lavator Wash Basin Drinkln Fountaln <br /> Water H08ter RA'(rl eratlon Shower � Fioor Draln <br /> Gas F1re lace Wood 9tove KltChen Sink&Dia osal Grease Tra <br /> pas R�n a Ductln Dishwashar Root Dralns <br /> Cfothes Dr er Hooku s Other Clothes Washer Medlcal Gas <br /> Ran e Hood Water Heater <br /> Other, <br /> Exhaust Fan ' S1nk Servlce/Bar/Mo letc. Other: <br /> ' �PRINKL�R�I SUp�Re$$ION $YST8IVI , <br /> Number o e� g <br /> AGKNOWLEDGEMENTr/heve ravlewed�hls app!lcst/on end oonRrm the lnformaflon oontalned here/n/�G�ua pnd Cvrrect.Work done pwsuant to th/s permlt must campry wifh <br /> ourrenf ladsisi ateta,end racal law, Tha qrenr�rig of e perm�t vMy euthorlaes epproved work end no devleUons fhere�rom,Davlatloris must Ar�t ba eufhorizedln wrlfing/rom rhe <br /> 9uilding Offlclal bafore baing eufhorized under any clrcuinsfenae.1 am�ne awne,or 1 am aulhorhed by fhe ownar o��h/s pmpe�ty to pallorm rhe work lor whloh eppllcation rs made, <br /> and 1 oompry wirh ehe Stets Conlractws Law f8.27 RCW end 2ge,?OOA WAC, <br /> - Clfy of Everef�011lclel Usa pnly <br /> � PE.�tMIT# �` <br /> � � ��0 ���� � �� � <br /> Owner/Authoriz�d Agpnt IenNturv Dale (Revfse 3/20/2016) <br /> �� , �� <br />