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03/i3/2018 TUE ia: 53 F� a25 �15 6867 FaAt wdter Heater �002/002 <br /> �I � ��3 <br /> P�RMIT APPLICATtON <br /> Bl91LD13�`G/Nl�CHANICAL 1 i�L.UIUIBiNG/SI�i11!SFRIMKLER/DEMOL[TION <br /> CI"fY Of=EVERETT PERMIT SERVICES <br /> 3200 CE�Af�STRL'H"P,CVERE7'T,W/198209 <br /> (P)A23-257-8610 � �AK A25-257-8857 �(�)evereEG3ps�evcretlwe.pov� www.everetlwa.gav/perm{te • <br /> Blue or�lack �mk OnA �I�as�m 1P48��91�'C�'SM'1'R 1N�OYtMp,4MON �� <br /> � PROJECT S1T�ADDRESS; PRDPERTY TAX#: �� � <br /> 1��GAL for new canatruetivn, Snort pl�Usubdlvlslon Lot No, �ettach capy o�Iong legal d�sortpllan) <br /> CONTE#CT 1NF0lZMATIO�1 <br /> OWN�i�NAM�: � U 7�IVANT NAM�(14 Commerclaq: �'—"'�- <br /> OWN�R MAI�iNG ADDR�55: s-rRe�r � T�"� <br /> cm � sra� z�r� <br /> OWN�IZ AHON�: � � OWN�i�E1VlAll.: <br /> CON717AC'f0i�NAME: �T '� '� <br /> CONTRACTOR AADR�SS: S7REET �� �} � � <br /> crrY �� � srn�e zm ' <br /> cQ�lTRACTaa PHONE: ��S GVN7RAc�p1��MAI�; ��,1�1 1�� �"U.J �Jl' <br /> CON'fRACTOR E.tCEM1l3E#(REqUlRED): "r�} I'�' CITY 0��VCRGTT 6USIN�SS LIC�NS�#(R�QUIf2ED)• ��3 <br /> PRIMARY GONTACT; Cj OWN�R CON7F�ACTOR ❑OTHER(Piease Spec1{y) <br /> CONTACT NqME: CONT1aCT PHOAlE: � <br /> i��� ��'i'�`/� GpN'CACT�iV1Al�: •�V�Il�1'�S G�Qt, �� ��M <br /> BUiLD1�1G �ERMST��P1.MCATION <br /> � ExlefEn Use of Bulfdin ; " ContracC F'rfce aP Work:$ � <br /> Prv osed Use of�ulldin : Fleat Source: Gas ❑�lec�rlc �Other " <br /> Buildln T e: R-Detached �SFR Aftachad ❑Du leX C]Multt-Fat1'lll -#af Units: qComm�rclal �Industrlal <br /> a of Pro'ect; ❑New DAddition �Remodel Re afr �T.l.' �7Si n C�5 rinkler l�oemolltlon �ICh�Itg�of lJse <br /> DE9CRlPTfON OF WORK: <br /> �iM ��{� � r2,��,o�C� C�1--S +�o��-�e� �1,�Q,�� <br /> A830CIATED BU(LDf�IG PERMIT# IF a ilaqple� <br /> M�CHAI��Cl�#�P�RMtiT APP6lCATION pLl�1Yl�lllyc3 pLLilVip7 APPLICJ�TION <br /> Type oP ProJect: �low,_, Atldn .,_Alteration _Aapefr 7y�re of Project: _{Yow ,,,_j�ddn _Jliteratfon „TRepsir <br /> Flxturas LfaP oP Flxturea ���e8 Lfst of FJ�uras �,��� Llae ef I�Ixtaras �lxEures Bt oP Ftxturas <br /> A/C--All'Hpndlin UnIC9 H��t Pum Tpll�t Be�Gkf�ow P�venter nBid9 Bttl � <br /> � �orced AIr S stems Unit Heator Sathtub Urinal <br /> ` Gas Pf fn So�1er Lavata W h Basln Drin Fountaln � <br /> at�r H�afer Refr1 eratlon 5hower F r Draln , <br /> Gas Flre laca Wood stove Kltchen slnk Dis oaa! r��se Tra � <br /> QaB Ra� e DuCtin Dishwasher Roaf Dr�ln6 <br /> Clolh�s D er Hooku a Okher: C�otites W�sher Medlcal Oaa � <br /> Ran e hrood Wat�r Heater Ofh�r: � <br /> �xhaust�an Sfnk Servlcel o to. Oth�r: <br /> s�+�t�w �ssio � � <br /> einlael ar W .af Ftaads ' <br /> ACKNOW��DCaEM�N7:!have rovlewed Vlls applkaflon 9nU conl�im fha,D�/wmaNun confalned hereln/s true end cohacf.Wor7r done pursuenf!o fhls permlt muet comply w!!1r <br /> cunenf/eCerel,efete,andlocel law.The�rsnHne of a perml!on(v aulAor/zss approv�d wo�k and no devleUorrs�herelronx devleflons mual ll+sf be aulhakeaf In wr�flna ltwn the <br /> BUNulnp Oftlela/Ue/ore be/ng aulhorked unde�any o/rcumstanca.1 sm B�e owner,or I em autt,orized by the ownar of�hls propsrlylo petYorm tHe wrrh forwA/o7f appllcaHun fs mede, <br /> end)camp/y wlli�thA Sl�lO Oohlr9olaa LaW 76�27 RCW and 29�200A WAC. . <br /> ciry of��reron ofnarer uso o�ry <br /> -- I 3 -- I g �ER"�'.1, �� -a�� <br /> Own uthor ze Ag Slgnafure �ate (Revlaed�3/209Q) ' <br /> - ..�....�,,....,...�M.._ I....._.�W.......Y._......__._ / <br />