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i2/28/2V16 wED i0: aa FAx Fa�t water Heater �JV�2/005 <br /> � '��Rnn« ,����.i�,��r � � �� l�� .... <br /> �� <br /> �UILDiNG/ME�H�AINI�C�AL/pLUIV1�ING/SIGN/Sp1��N�LER/D�IViAL.1�"I�N <br /> CITY OF �V�F2ET7 P�RMI7 S�RVICES <br /> 3200 Cedar St., Everett, WA 98209 425-2�7-88�b FAX 425�257-8857 www_everettw�,org <br /> SITE AI?DRESS: ( ,i�� pR0 EftTY TAX 1� P RMIT# <br /> � � � �� l�l ' ' 1 <br /> �.EGAL Por ngW constrUotlon: Short platlsubdlVlelon Lvt No. <br /> (attaaN copy of lon�legel descrlptton) <br /> OWNER �`I' H�i S b Phone/�-mqll "I���� g <br /> F�ddrass Clly/State/Zlp ; V '�'� qg� I <br /> 1 � <br /> APPL,ICAN"f:_Owner �p,ry�er'e Agent Cont��ctor �Contraator's A ent <br /> 9 �Tanef�t(masl provltle o I�her ot canaert�Gom ihe awner to do wark In I�e apecn) <br /> CONTi�ACTOR �� • '� ��- State Lfa# �/U1AJ I--� ��,Clt �us. Llc. <br /> Address � �� � N �^ 'Y''K�V�'f �C-� Lo l�� ( /� <br /> (Q. �J - Phone/Empll �±'j(F1'3 � ryl'1 �.I--S ,f� � <br /> E .A�fVT BUSI 5S NA � CONrACT FO�PERM17' pt��-, <br /> �� ��V� <br /> F'hone/E-mpH � � � � <br /> BUI�DINa PERMIT 4RPL.ICA7'IdN CON1'RACT Pi�ICE OF WORK a °�' <br /> Existing Use of Bullding FiEAT SOURCE: <br /> Pfopos�d use � O�a Electrlc Other <br /> Eiultding typ�_ Ingle Famil �Duplex TTownhouse Multl-Fsmlly �Commerclal <br /> T e of ro'ect: fVow Addition Remodel R� f T-I. Si n S rfnkler Demolition � Chan v of Use <br /> D�SCRIPI'IQN OF WdRK(additlona�apace p�ovlded orr the beck): <br /> .��V►/�0 v ' <br /> � �� �� � S � � � <br /> � , � <br /> MEGHANII�AL PERMIT APP�,ICA7�ON P�.l1MB�N�3 pE1Z,MIT 4PPLICA7"IdN <br /> Typa of proJect: �New`qddn ^q�feration_Rapglr Type o(Profect: �w`.4ddn Altvratlon Rep�lr <br /> Show Numbgr # oP I/xtcrres 5haw mber # vf f/xturse <br /> A!C—alr handlin units oflet <br /> For�ed alr a steme B thtub <br /> Gas � �� La fd waeh 6asln <br /> Water heator Sho r <br /> Gas fl�e lace Kltche sink&dls sal <br /> Ges ra� e Dfshwa er <br /> Clothes dr er Clothes �S r <br /> Ran e hood Water ha r <br /> �xhaust fan Sink vl Ibar/mo /otc. <br /> Heat um �a ow re entor Insfde bld <br /> Unit heater Inal <br /> Boller ' <br /> Refrl aratlon brfnkln �ount n <br /> Woodstove Floor draln <br /> Ductln Greaee'tra <br /> Other aoaf dralns <br /> SPRI L�R / Medical Gas <br /> ESSiOM SYS EM other: <br /> Other; <br /> �her�by qenlfylhet I e�ev�rgad�nclsxeminetl Ihle applloatlon qnd know the aema to be lrue and correat.All prov�slona of iaws and ordlnllhcae governinq thl�lype oPwork wlll De aomp <br /> wlth whgtYlor epeClFletl heraln or nat.1'h���anting oP a permlt do@S not preeuit��to glve sUlhorlty EO vlolaEe artancel thg provlblon o(eny vlher Bt�ttv or locel faw regulRling conyiructlon <br /> Thet I�m mUthorlZetl by tha owrer oF lhlg pYopert to perfarm In�Work forwh�ott eppllpetbn le mgd��nd f comply wlth tng Slate Conlraatora Law 18.27 RCW antl 296.200A Wq�, <br /> Own�r/A�t r x�d Agent Signat � � / �� ' � "" <br /> Dale <br /> (Rev/sed 4/201G1 <br />