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O9/18/2017 MOx 15: az FAx Fast water seater �pp�/pp9 <br /> , ` ����� <br /> pERMIT APPLIC�►TION <br /> i�l31RDING/MEC'HaN(GAL./PI�UMC3ING/SIGN/SPRIN4CLER!D�MOLtTION <br /> CITY OF EVERETT PERMIT BERVICGS <br /> �200 C[DAR STRL�'P,CVERETT,Wh198201 <br /> (P)A25-257-Bg10 � FAX 425-257-g857 �(E)averettapa�evereRtwe.gov� wvnrv.everellwa.gav/permite - <br /> Blug ar�lack�nk pn� Pl�as� �+ROJI��'q`SM'1'�lNI�O@�IIA/1,�'10�9 <br /> Rl�OJ�CT SfTE ADDRESS: 3� PROPERTY TAX�: '��D D' � <br /> LEGAL For new conotruction: Short Pl�tlsubdlvlelon �ot No`,,,_ (aEtach copy of Ia�g I�gBI aaacripHan} <br /> CONTd�1Ci'IMF�IiN1AT10N <br /> OWNER idAM�: (� 'F1�NANT NAM�(If Commeralal); �"^� <br /> OWATER MA[�1NG AI�b1Z�5S: BTREET C/ N� L W <br /> crrr srn� z�r <br /> OWhIER PHON�: OWN�R�illlAll.: --- <br /> CONTt3AG1'Ofl NAMH: '�' S'r � T <br /> CONTRACTOR ApDR��S: 8TREET �"� s � <br /> crrr 'Q � 97A7E am ` <br /> CON7til�C'fOR PHONE: �'�s � coar�acr����nA��: ��,UY1 ti�S �-u1 -�vY, <br /> CONTRACTOR LICEiV3E#(R�QUIRED:� '"rw �}' � ClTY OF EVE}iE'iT 6USiNE55 LIC�eMSE#(F2EAUIf2EL)) ��'3 <br /> PRllV1A�tY GOfVTACT: CI OWN�F COiV7lZACTOR ❑OThfER(Pleasa SpeclPy) <br /> CONTACT NAME: CONT!\CT PMONE: a-rJ' <br /> K,,�T� �.�1�1'L`�. coNr,acT�nnAr�: vV�i�S v�Ol: �', f��M <br /> BUELDINC,�P�RMIT APPI.ICATION <br /> � ExisEfn Use of Buitdin : " ConErscE Prlae of Work:$ �' <br /> Pr4 ased Use of aufltifn : W�et Soul�ce: Gas C��le�trie ❑Ol�er �- <br /> Bul[dih e; FR-Detached OSFRdlttached �Du lex C]Multl-Famll �k of Unifa: QCommerclel C]Industriql <br /> e af Pra"�ck: O1Vew L7Addition ORemodel Re air [7T.1. C75i h 1�5 Ytnkler ❑DemollFlan bChan e of U9e <br /> DESCRIPTfON OF WORK: <br /> �i�n D�1�° � r����C� C��-S v�o�.�--e�r �1 �a,�� <br /> A�S$OCIAT�D BUtLDWC7 PERM[T a�(IP p I�cable: <br /> M�CHAN�CAL P�RM1T�APP6ICATION �L��I�II�MIVO ��RMAT,A�Pk.1aA'y'MO� <br /> 7ype vf Proloct; _,New� Adan ,�Iterst�on _Reparr 7ypa o!ProJ�ct: �1aw �ddn �Itsratlon �ep�ir <br /> Flx�tu as �rsr'oP Frxturas F,��°ea �lsr af�lxturas �1xtu�res �� F7x u t s L/at of 1�rxt s ; <br /> /UC�/�lr Handlin Unitb Hleet Pum 7 I�t eackf�ow Preven Illslde B�dg � <br /> � Forc�d Alr 5 stems Un(t Heater athhrb urinei <br /> ` Gse Pf In Boller avato Waah Oasln Drinkln Fo tain I <br /> Waf�r Heatsr FqeF� eratlon hower Kloor D <br /> G$s Fire fsce Woad 5tove ltchen Sink&�le osal Grea ra � <br /> Gae Rsn � Duciin shwash�r Dralr�g <br /> Claihea P er Hooku a Other: C thes We�her al Gas i <br /> Ran e Maod W r Ne�ter Other. � <br /> qchaust Fan Stnk ervlce/�ar/Mo /stc. Other. <br /> SN�t1N �$S10 M , <br /> emleal ar W A.01 MeQds ' <br /> ACKNowLeDpeM�NT.I have revlewatl th1Cs epp/rcaBcv,end conHrm!Ae lnibrms!(on contalned herek�Is trus and cor�C Work done purauant lo thla perm/t muat compty w1Eh <br /> currenf fetlara/,sfeta,�and locsl�w The grentlnp o1 e permlf only atdhorizss approved work�nd no devl�oons thmre�l�om.Devl�flonm muet Anst be suf�erlxstl m wiltlna hnm tAe <br /> B!Nltl/ng Otf�cla(beloNs being eutAor/zed under eny clrcumetBnca 1 om tbe pwner,or!am aufhaized by the awnar af fbla prope�y to perfarm the wark forWhlch eppAr�fkn fe merle, <br /> and/co,�pJy wIM�}ha 31ata Con��olora Lew i9,2r l2GW end 29d200A WAG <br /> Clfy of�er��o�/Ic%I use only <br /> ✓ f�� (� PERMI'T#y�/� �� ��O � <br /> rv � <br /> Own ulhor e Ag 8Egnature Dg6e (ReVlSed <br /> ' � <br /> ,� , ' <br /> -- - �__.��_.-,.....�..�^ <br />