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pa/25/2017 TUE 10: 99 FAx Fa�t water Heater 004/V08 <br /> ---�-----�-----..--.._...._..._t_._. _..--------...-----�------�--....-----..—.._... ---- - -,---...._.........._._..... ...... .. ._ . .._._. _.. ...._........_�1...._...- <br /> � • , <br /> � Oc�8�1 <br /> PERMIT APPLiCAT10fV <br /> 6UILDING/M�ChIAIV�CAL/I'LUM�1fVG /SIGN /SPRI{�IKI.ER/DCMOLI�ION <br /> CI'fY O!"CVCRE'TT P�F?M]T SCRVICES <br /> 3200 GC�AR STR��'T,CVERETT,WA 98201 <br /> (P)426-267-8810 � FAX 425�257�8867 �(E)ev0retteps@AvarellwA.gov� ewwi.evereuure.gov/pormits � <br /> (Blue or Black In[c Only Ple�se) PFtOJ1QC�'$ITE It���RMA�NON <br /> PE20JE�CT 51TC Al7DR�6S: PF20PERTY TAX#: D � <br /> L�GAL.Por new canatruetlon: Short Plat/subeiNlslon Lot No. (altach copy of lo�g�egel deacdplfon) <br /> CONT�ICT INFORMATION <br /> oWN�R NAME: 7�NAN7'NAME [P Corr�merclal : 1------� <br /> OWNER MAILING ADDREgS; grn��r S'� - <br /> CRY 97AT6.��' Z1P <br /> OWNER PHON�; OWNER EMAIL: �� <br /> CONTRACTdRIVAME; � S� � r <br /> CON7fZ4GTOR ADDRE55: arReer � S - <br /> CRY (/ � � 6TATE zip ' <br /> CoNTt�AGTOR PHONE: �-'�a S - � CON7fZACTOR�MAII�; �V}'1 �T S �'1,U �. D <br /> CONTRACTOR LICEfY3E#(REqUIRED): � � � G7Y OF EVERETT BUSINE3g��C�NSe�(R�QU�R�D): � <br /> .. . . . . . . <br /> PRIMARY CONTAC7: CI OWNER (�CON'1"RACTOf� 0 OTHER(Pleaae Speclfy) <br /> CONTACT NAME: CONTACT PHON�: y� � <br /> K^ ��v� CONTACT EMAIL: � I�� .S"4'U+�QI, �vl' � �/(SVI� <br /> grllLDINIG pL�F�tVll�'APPLICATlON <br /> � �xfstln lJse of Bufidln : Contract Price of Work:$ � <br /> Pro ased Use of Bullclfn : HeeC Souro6: aGa9 IeCl�lc ❑Other � <br /> �ul1d111 6: FR-Detac�i�d OSFR�Altachad �Du lex �nn�uu-�amil �of Units: f�Commerciai �Industr�ef <br /> 7 e af Pro ect: C�n�ew G7Addltlon ❑Remaciel Re afr ❑T.l. O51 n OS rinkle� L7Dom011tlon �1Ch�n e of Usa <br /> b�SCRIPTION OF WORK: <br /> �-�v�n o�� � ���p1��� ���n'C, �o��� �,�a�1-�� : <br /> ASSOGIAT�D�WLDINa PERMIT iF If a Ilceble: <br /> M�CHANICA�P�RM1T APPLICATMOI�I PLUNlBIN� PERMIT/APPLICATION <br /> Type oY�rolaclt ..y,.Naw Adc1n ��IteraHon _Rapalr Typ�of ProJect: _New _,Addn _,Alteratlon _Rapelr � <br /> �1 of Llst ol FIx #°� Llst of Flx � �°� l.lst of F/xiares �°� L/st of Flxtures I <br /> Fl�ures �lxturss F1xlures Flxtures <br /> A/C—Alr Nandlln Unit Hea!P Tollet Backf�aw Pr�vonter lnslda Bld <br /> � Fo�Ceci Alr S stems U ealer BsthtUb Urinol I <br /> G�s Pl In olle� Lavato Wash Basin Drinkln �ountaln <br /> Water Heater Refrl eratlon Shower Floor Dreln i <br /> Ga6 Flre lace Wood Stove Kltchen Slnk&Dle osql Greese Tra � <br /> Gas Ran e uC�ln Dlshwasher Roof Dralne � <br /> sI D ku s hor� Clotnes Washar Medlaal Gas ' <br /> Ren e Hood Waier Heater Ofher: I <br /> �chauat�en 51Rk Servlce/BadMo /etc. Oth6r: j <br /> � <br /> $PR1N �SS10 1FS'C�4M � <br /> ,emlca!or V ,of hleade <br /> i <br /> ACKNOWLEDGEMENT'/heva rovlecyed thls appllcallon end conllrm fhe Inronnerkn cnntalABd ABrebl(s Irue artd convCl,Work dona pursuent(o fh/s pem,lt must compiy wRh � <br /> currenl federe�s1a�s,and loca/law.7he BrenrhrB af e permft on(y aulhorizes epproved work and no davinflons Iho��rom.Davla!lons musf tlrst De aulHorlaed In wrHing hom fhB ' <br /> Bu!!ding 071c1a1 belore being�ufhoNzed und�r any clraumelance.I�m IHe owner,a�!am eulhorfzed by 1he owneroP(h!a propedY�o padarm the»rorh/er whlch appllcellon Is rnade, <br /> anU l aomply wl1A(�e Slate Co��rQctora�aw j&27 RCW and 29At200A WAC_ . <br /> Clty of Everetf OH/ola!Us6 Only � <br /> � _ �.�, �� p�a��Y� , b l b,--� : <br /> own utharze Ag 3ignalure Dete (Revse 'lof ) � <br /> i <br /> I <br />