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07�08�2016 FRI 12: �Q FAX F��t water HOatOY f�D03/043 <br /> • . . . I <br /> .-... �P�RMi�" API�L(CA"r°`� C��a.�S" ._..... <br /> BUILDINC/MEC1-IANICA�./PLUiNI�IN�/SICN/SPRINFCL�R/DEIVIOLITI�N <br /> CITY OF �V�RETT PERMIT SERVICES <br /> 3200 Cedar St., �varett, WA 95201 425-257�8810 FAX 425-257-8857' www.everettwa.or� <br /> SIT ADD�ES3:� S S� ���� PROP 1' X � � UD MT# <br /> LEGAL 9or new Consfruchlon. Short P1atlsubdlvlalon ' <br /> Lot No. (attach copy of long IApal descrlpUon) <br /> o�,��R ,� � �� �� a o � <br /> PhonelE-m�11 <br /> F�ddress I�%� 'r '�' � ��,b f CIly/Stdte/Zlp � ��jf� g� <br /> APPLfCAPI'f:_Owner _Owner's Agent�Contractor �Con#faCko�'9 Agent _TB�Bnt(muBt provme e letter ofcanrvnl Prom the owner ro Uo wnric fn lha apace) <br /> CONTRACTOR � � • �, � Sta#e Lic_# �/IJjA,1 , g�Clt �us.Lic. <br /> Ll� (� N � �vul — a cc <br /> Addreas L S' (jfQ, W • Phone/Emall a��3 ✓bi!"�':S -� <br /> ENANT BU91P1� NAME CONTACT FOR PERMIT r, <br /> ..�--�' �"i"� ��V� <br /> Phorte/E-mait 6, � <br /> BUILDING P�RMI'1"4PPLICATIQN CON'�l2�ACT PRICE OF WORK �'" <br /> �xisting Use of Bullding � �� H�AI"SOURCE; <br /> Propoaed Use of Buildln Ges Eleceric other <br /> Building type: _S[ngle Fam[ly ,Duple�c_Townho uitl-Famit �Commercla! , <br /> e of ro eCt: New Add�tian Remoc! �Re alr T,I. 5i n S rinkler Demofitlon • Chs e vf Use <br /> DESCFtlPTIpN OF WORK�adamonaispaceprov�d�don � ack): <br /> ����r 1�. c.� � � . <br /> �P ���r <br /> M�CHANICq1� PERMIT' qppLIGA'f'ION P�IIMBING P'�RMIT kPPLiCAT�pN <br /> 7'YpQ�ProJect: _„_,Fiaw_�qddn _Aliaratlon_Rapglf Type of ProJect: �New_Add� �lt�ratlon_�apalr <br /> 5huw Num,ber o1 f/xlurg$ Sh0 m�er of�lxfur+�s <br /> A/C—afr handlin units Tollet <br /> Forcad air s tems athtub <br /> G'�g � �� L vato wash basin <br /> Water heater 5 ower <br /> Gas flre lace �t hen slnk 8 dis o I <br /> Gae ran e Dis washer <br /> Clothes dr er Clot s waeher <br /> Ran e hood Wate heate • <br /> Exhauat fen Sink s rv e/bar/mo /e#c. <br /> Meat um Backflo reventer inaid�bId <br /> Un�t heater Urin - <br /> Soiler . _ Dr' 'n �o ntaln <br /> __. <br /> Rafri eratton oar drain <br /> Woodstove �rease�tra <br /> Ductin Roo�F drains <br /> Other Mgdical Gae <br /> SPRIN PRES$1 �M othsr: <br /> ot Hea Other: <br /> �hareby GOHIly lhet I have roiad and examinetl 1NIL appilcallon end khvW the aeme lo b�true end corl'eDt.Ap provlet0�4 af�aws end orrllne�Go6 goverhing thie rype qf wp�k WIII be comp <br /> WIt11 whetfler speallleC her�fn or not Thp grmnting oF a F9rmlt doea nat preeum0 to plVe eulhorlty to vlolate ar canGu tfls provlalon of eny Other siate or locel law regulaltEn9 QonehucUo� <br /> 'r'h�l�am authorued by tl�vwner of titts properfy to periarm�he wak inr wnlqq epplfoaElon Ia m'de end I comply witti the Stale ConttaC4ors Eaw 78,27 RCVJ enp a80�Z00A WAC. <br /> �$� � � <br /> Ow Au orl�@d gen Slgn ur� O�t� (aAv/sed 4/201�) <br />