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�$/O1/2�17 THU 16: 26 FAX F��t Wat�Y HOdt�Y _ _ _ �QQ�/p�s <br /> .-..�.o.,.,�....,..�..��-p...,.,�.......�......�_..._..,__.' ---�� - ___ ...,._..........._._,.._._�....._.,�...Y,,.._...._ - -�.'� <br /> � PI�RMl7 APP`fCATION <br /> �� �� `� <br /> RUiI.p�N� /iVIECHA1111CA1./P�.UMBINQ !�fG�1/SPR1N6fLER/DCMO�ITION <br /> CITY OF EVERETT P6RMIT SERVECGS <br /> • 3200 CEDAf�STRLCT,�VER�TT,WA 88201 <br /> (P)425-257-881a � �AX 425-257-Oti57 �(E)everolfepa�everettwe.gov� www.everettwa.govlpermfta � <br /> Blu�or Bl�ck�nk�,�I �+leas� P�OJ@CT SI7�lPiPOttNipTION <br /> PROJ�CT SITE A�DRE58: � �� PROPERTY TA}(#: � D�U'J�$DD � <br /> LEGAL Por naw construotfon- Shor{PI@Vaupalvialan Lat hlo, (sttecn capy of lana ioga�descrtptlan) <br /> CONY,�CY r�r�o�n�arro�M <br /> OWNER NAME: � - �N TENANT NAME ii Commerclaf): <br /> OWN�IZ MAILING ADDRCSS: smeer � �� � 1�t� <br /> GrfY 97AYE 21� <br /> OWN�F�pIiON�: �O OWNER EMAIL: .�—"� <br /> CONTRACTOR NAME: S� �. � <br /> CONTRACT�F2 ADDi2�55: srneer `1%�"`� N C/V'Q� �iwvri S <br /> crrr � � srn� zir 1 <br /> CON7fZAGTOR PhION�: �'�p�s � GOiVTRACTOIi�MAIl�: ��VY� �T S �'UJ <br /> CONTF�P.CTOR LICE[$36#E[REqlJIRED):� �'rw �}N' CITY DF EVL�liET'['@USINESS LiCEPIS��!(REQUIF2E1�) ��'3 <br /> pRlIV1A�tY CqNTACT: CI OWNER (�CON7l�ACTOR �OThIER(Pleasa Speoify) <br /> CONTACT NABIIE: V CONTACT Pht0111E: � <br /> K�� 1����� CONTACT Ei41Af�: .�jlrvl/�,I-�-� � �.e,fr, �� <br /> BUI�.DINO P�I�ilf�l�,APPL�C,Q'T�ION <br /> � �xiatln Use of klulldlrl ; Contract Arlca o�P Work:$ �' <br /> Pro osed Use oF Build(n ; Meat Sotirce: Gas ❑Clectrtc ❑Olher � <br /> Bul(d�n e: FI�-qetached C�SFFi AUaohed ❑Du lex CIMuItF-Fam[f -#af Units: �Commarclal Dlndustriai <br /> e of Pro ect: C1New 1�Additlon C7Ftemvdel Re alr �1T.1. CISI n CIS rinkler C�Demallklon ❑Chan e of Use <br /> D�SGI�Ip1'ION 0�WQRK: <br /> �irn p�l� l �e,�10�,�� C�}-S w r�.�� �1 �0�,� <br /> A950CiATED BUII�pING P�RMIT# If a Itcebfe: ' <br /> WI�CN4NI�AL P�RM1T APPLI�ATlON PLUMBING P�RMIT�IPPL�CATION <br /> "ryp�o}ProJeui: �Vaw_ Addo _.plteraElon ,�ReAalr Type of Prolect: _NBw �ddn ,�►iteration �tt�pa�lr <br /> #ot �Iet of FiGctules �oi L/af ofF7xluF4s #o� �(st ofF/kh�� #01 Llat of FlktUlt9s � <br /> flxturas Flxturas Flxfures FJxturas I <br /> A/C—Alr Nandlln Units Hee�Pum 7oileC Backflow Preventer Insld Id <br /> � Forced Air 5 elema Untt Heater Bat �rinai ! <br /> Gas Pf fn BolleP L ato Wesh Basln Inkln Founteln � <br /> Wsker Heai�r R�frl eratlon hower �i Draln " <br /> Gas�tre lece Wood 5tove <ttchen Sfnk&!?fe osal Graas Tra � <br /> �ae Ran � Ductln Ishwaeher F{oof Dr � <br /> Cloth�s D er Hooku o Othor; C thea Washet. Med tl j <br /> Rpn �Hood W8 Heate� 8P: • <br /> F�chsust�an 5lnk ee/p�NMo�/etc. Other: • <br /> SPRIN �� E;S�10 tU) � <br /> emlcal or W .of Heade ' <br /> ACFWOWLFDOEM�AIT.'I hdVe rovlawed t!r!8 eppllvaflon eRd conp�m fhe Infarmaffwr coqlalned ha�ln/s true end comec!Wark done pu�uent Fo fhls pelmltmusf tompJy WlfA' � <br /> cunanl l�eral.atete�entl/ooel lew.The granrUrq af e parmtt only auf�ses eAproved work and no deWarlons fhorefiom.Pev/ei/otls must llrsf ba authorized/n wdl/nq Irom fhe <br /> 9Wld/ng ofRolel belbre being eulhorhed vnderany cficumsfenca 1 em fhe own�;or1 am atrfhwlzetl by fno owner of(bla properry lo perrorm�he wailc forwhkh appNeallon�a nrada <br /> end 1 comply w/1h tBa Slafe GonfracloYs LaW 9�27 RCW antl2BB.YoaA 4yQC. <br /> C/ty or�varait oHM1�l use Onry � <br /> PERMIT � • <br /> � ( r ` � <br /> Own uttior ze Ag StgnaturA Dute (Revlsed B/23P101�) � <br />