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10/05/2017 THU 12: 05 FAx Fa�t water xeater �002/Op4 <br /> . • <br /> PIERMIT APPLIGATI�N <br /> BWILRIN� /MECHANICAI,1 PL,UM�ING /SiGN I�PRINKLER/ DEMOLlTfON <br /> CITY OF�V�RETT PERMIT BERVECES <br /> 3200 CEDAR STREE-f,EVERETT,WA 8820'I <br /> (P)425-257�fl810 � FAX 42b-25�-8857 �(E)evereitaps�evereuwe.gav� wvnv.everetlwa.Bov/permfte � <br /> �Blua or Bl��lr Ink Orsl Pleasa �1tO.D�C4 S17E lNP06iN1A4�ON8 � <br /> P�t�J�CT SlTE ADDRES3: I�D L � PROPERTY TA?(#: � <br /> LEGAL lor new constructlon: Short PtaUaubdfvlelon Lot No. (altach aopy af long 1sgAI tlescdpUon} <br /> CON1'ACT INFOkZM�A,TIvN <br /> OWNEFt NAME: 7�NAN7 NAM�(i1 Commerclal); <br /> OWNER MA[LltJG ADDR�SS; 5ra��r � <br /> crrr V aTn'rE zlP Ov <br /> OWfVER PhfON�; � OWN�R EMqlL: �� <br /> CONTRACToR NAIVf�: � S� � � "r <br /> CDNTf�ACTOR ADDRE83: srRE�r �'� � � <br /> CIT/ D �. BTAYE ZIP I <br /> CONTRACTOR PHON�: ��� CONTRACTOR�MA,I�; ��.IM IT S }'UJ I'�, D <br /> CONTRAC7'Of2 LiCElV9E#(f2�QUIF2�b): S � � CI7Y OF�V�RE7T 9i1SIN�SS LlC�NSE#(t2EQUt12ED) �'I�'3 <br /> PRIMARY CbN7ACT_ 0 OWNER CONTRACTOR �OTHER(Please SpectFy) <br /> GONTACT NAME: CONTACT PHONE: a� <br /> ���� ��v� CONTACT E1YlAIL_ �;�-�-5 �� ,�.�, ��� <br /> F.iU1l.pIN� P�1�1►I�IT,APPLfCA�'ION <br /> � �xlstfn Uae of Buildln ; S (Z, ,� contract prlce oP Work:$ �c <br /> Pro osed Use oFBuildi � -�--G I-leat5ource: ❑Gas Floctrlc ❑Other � <br /> guildln e: l�SFR-Deteched R-Attached ❑Du I�x pfNulU-Famll -�#aP Units: I�Commerclel L7lndustrial <br /> e of F'ro ect: ❑New L�AddAion C7Ftamodel Re alr l�7.1.' ❑51 n CIS rinkler L�DemollClon C7Chan e of Use <br /> fJ�SGF�IPTION O�WOkK: <br /> �Y V I V V� ! �l��1�/�,l��j 'V 1LV� 1 � C W(/v"�L� � �V��`� I <br /> 7 <br /> A3SOGIATED BUILDfNO PERM[T# If H 11ceble: <br /> M�CHANMC,Ai.P�EtIV�I'�'I�pp�.IC�1,XlON P�lliN1l��Nt� P1�Fi1V�pT A�aILyCI�TION <br /> 'fype o�ProJact: �lew_ Addn �Itaratlon �a Ir Type of ProJect: �New �ddn <br /> JAlteratlon _,Rapalr <br /> �°r l�c[uras �°f Us P F(xturoe �°f L/s[of�lxtures #�f Llst of�lxtures <br /> Flxtures F/xturas Flxture� F/xtures ' <br /> A!C�Alr i-landlln n[ts st Pum Tollet BaCkfloW Pteventer lnslde Bldg I <br /> � FO�aed Afr S stems Unit Heata� Sathtub Urfnal <br /> ` Oas PI in ,Boller LBv�Eo W�tah Basin �rinkln FOunteln � <br /> Water Neater Refrl aration ShoWe� Ffoor Dialn � <br /> dae Fire lace Wood Stove Kftchen 51nk&Qla osal Grease Tra � <br /> Gae Ren D Ductln Dishwasher Raof 6ralna <br /> GIo1h�s D er Flo s Other Clothes W2sher M�di�al O�a i <br /> n e kood Water Heater Other; <br /> Slnk Servtce/Bar/Mo /etc. Other. <br /> SPRI1� �SS�10 !V� , <br /> emlcal or .af Neads ! <br /> ACI<NOWLEOGE'M�NT`�hav6/eV19We[I thl6 epp11o81lon end oonlf/m lhe I/]lo�netlon GVR(a/nOd hereht Is lrue end corre�f. Wprk plp�p purauent fo rh/s psrrn/tmusl cwnp/y wlth <br /> currenf(edaral,stafe,ana roval lew,TAa grenfing pl e permlt oRly eutfrorlres apprroved woNt sntl no davla!lons fho�efiom.pevlotJons mu�f llrsf De ou!/�a/z�U M wrlfing fivm tha <br /> Bu!ld�ny OfNcla/bePoio being aulhomed undar any cf�+msfenee.I em fhe owner,or I em eufhodzetl by the owner of�hla propo�iy io pe�farin Fhe wodr for whlch sppllcatlon fs matla, <br /> Antl l OomplyWl�A f118 Stafe Con�raCtOlS LOW 78.27 ACWand 29dZQ0A WAC� <br /> Clly of Everett OHIcls!1.(ve On/y <br /> � ' � � I � P�I@MI7,� � � ' <br /> � <br /> own uEh�rze Ay Stgneture Date (RevleaJB/23 09� <br /> -----�------�—,--._._....,.,. '.�..�._.. _ I ._.__�_—_ <br />