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06/19/2017 MON 1�: 58 FAX F��t water Heater __ f�0p�/p05 <br /> ,�..�..._..�-------• .. .. ---- ...-- --- --.,.�...__.�.,w.�_._.�......,--_..�. <br /> .W.�.�......�,.��._,...�,.,._, � __ _..,.........�_,.�.�._.��...M..,..._��„_.....�..._...r,�_..--,.— <br /> � �O�bB� <br /> � PIE�MIT APF'LICA'�lON <br /> �U1�.17�NA I MEcHANIc,A�,i PLUM�tN� !sr�lv i s�Ri�rKL�R I D��IaL.ITION <br /> ClTY OF GVFRETT PERMIT S�RVIC�S <br /> 32d0 CEDAR STREET,EVERETT,WA 9820'i <br /> (P)a25-257-8810 � FAX 425�257-8057 �(�everatteps�evereltwa.gov� www.e�eretlwa.�ovipermtts � <br /> Blue or Bfack Ink Onl P�eas� PKOJ�t�T SITB lN�O[tMATION <br /> PROJ�CT SITE ADDRES3: v� �[ � pi�QP�fZTY TAX#�: �' � <br /> LEGAL for nawwnstruc�lon: short Ffat�eubdlv�slon Lot No. (�ttach copy of lonp lagat descripllon) <br /> CONXI�CT 1�1FORMA71oW <br /> OWNER NAM�: TENANT NAME(IT Cammerolal): <br /> OWNLft MA161N0 ADDRESS: smeer � �^ <br /> crrv srnT� am <br /> OWMER PHONE: � � � dWt3ER EMAIl.: �—^—�-----� <br /> CONTRACTOR NAM�; � S� � `� <br /> CONYI4AGTOR ADDRESS: BTRBET � I S � <br /> CRY � 8TA'IL � IIP t <br /> CONT�tAC7'OR PHONE: ��� C� GONTRAC70�i�MAI�: '�{�,VY� IT S �I"V.� �. <br /> CONTRAC70R LICENS��(R�4urREn):'� 'rjN �'�' CI7Y bF EV�R[�TT BUSIN�Ss L,IC�NSE�J(R�QUIF�D)• ���j <br /> .. . . . . . . ... . . . . . . <br /> PR[MARY CONTAGT: C.�OWN�R CON'Tt2ACT0� 0 OTFIER(Pfease Specify) <br /> CONTAC7 N�AB7E: CONTACT PHONP: � <br /> t��`�'� ���� CONTACT EI1�fA�L. .�y�;� � .�•, �y�/� <br /> $,Ui6DI�+ACd P�RI��T APPLICA'i'!OW • <br /> _,! Exiatin Uae of Buildin : 1 � Coptract?rica pf Work:$ �' <br /> � Prv osed Usa of 9ulldtn : Heat Sourc�: �Gas lectric ❑Other �- <br /> Bulldln T e; FR Detticlied ❑S�R-Attached ❑Du lex 1�Multl-Famll -#of Unfts: ❑Commerclal Dlrtdustrlal <br /> e o{Pro ect �New C7Addltlon LlRemodel Re alr C�T.I. C1S n I�S rinkler ClDemolitfon ❑Chan e of Uae <br /> DE9CRIPTION Of-WORK: <br /> ���nn ��,� � r�,���.c� -zl-�G��L w�-�� ��a,-�W <br /> A830CIATBD BUfLDINQ PERMI'1'7� If� Ilcebfe: <br /> M�CHANMCAI, P'�Elil►IiT qPPL.ICATION PLUMBINQ P�RM�T APPR.ACA'A`II�N <br /> 'rype o!ProJect: vr� do ,�Altaraticn ,�Rapstr lype of Pro)eat _NBw �4ddn rAltaretlon �ep�lr ' <br /> #o/ af ol Klx�ures #°f L19�af P re� #o! �.�at of Flxtpi'e$ #of Ltst of�1Muros i <br /> Flxtures urea Fixtures Ffxtures I <br /> A/C A�r HandlEn Units H�st P 7ailel �acfcffoW Preventer It►slde Bldg <br /> � Fo d Afr 3 bams IJnI eatar 69thtub Urinal i <br /> o s PI in ler Lavato Wash Basln Drinkfn �ountaln <br /> W ter Heater ef�i eretion Shower �loor Draln , <br /> 0 FIre lace aod SFove i(Itchen 51nk&p�a oea! Gre�ae Ti� � <br /> G �sn e o tin plshwasheT Roo Draine • <br /> Glal b eC Hook Oth : Glathes Washer. Medlc�l Gae i <br /> R�n ed Watar Fteater Oth�r � <br /> Cxhaust Fan S1nk Service/�ar/Mo eM. othert • <br /> S��tIN �S$10 IVI � <br /> emic�l or W .01 Heada ' ' <br /> ACKNOlN��pGEM�/vr�1 h�ve rovlewed tnre applloallon antl cor►llim tha In16�mslbn eontalned hereln Is lrue erld correck work done pursuent(o fhls pam,lt most compy wllh <br /> cum�nt fedarel,a(a16�end�ac�l 1aw.Tbe greRffig ol a permt!oNy anlhoNzes approved wor1�antl no a�vb�lons fharefiom.l7evlatlorrs musf llrst be authorPred ln wrlNng 11�nm the <br /> BuUding GfNc�si berolra beJnB aursodxed uriderany clicumscaneo.l em f�re owner,or I em aufhorized by rhe own�r of fMs propedy fo pedfarm the worh for whlch appllcel�on la rrrade. <br /> end I comvh+wlll�rne Star�conrr�crors caw�e2r Rcwand2esaooa W�c, <br /> cry af,�vers(t omare�use Onry � <br /> � //� � ' � PLRM'f <br /> � � <br /> own utHorR� A9 stgneture Datia (FTevlsedd/23/�104) � <br />