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07/19/2p17 wED 9: z2 Fax Fa�t water Heater f��03/005 <br /> -�.�.._�—.—.;� _:....��..._ � �.....�.�_..�.- -:_,.�._Y,:.=:_..��.�____- <br /> ����� <br /> PERI!lIIT APPL.ICATION <br /> BUILDING /M�CM,�NICAL I F'LUI1fIBING !SIGI�I l SPRIN�LER! DENiOLITION <br /> CITY OF CVCRETT PERM]T SCRVECGS <br /> 3200 C�DAR S7R��T,�VCRETT,WA 98209 <br /> (P)426-257�8010 � FAX 425-257.8857 �(E)evereifeps�9var'�llwa_gav� w�,vw.�veretlwa.gov/permft9 • <br /> Blae or Blaak Ink Ord Pieaee) P�tOJ��T SIT� It��ORM,AXMONY <br /> PRO.fEC7 SIT'�Aa[�l��SS: 'o PROPERTY TAX#: Q� ' ObDO �DO � <br /> L�GAL.Por new co��atruotlon: snort PlaUsubcivlslon Lot No. (altach copy of long isgal deacrlptlon) <br /> CONT/�CT 1NPORIVIATl0�1 <br /> OWN�R NAME: � T�NANT NAM�(If Commerclal : <br /> OWN�it MAILING Al7bI��SS: s�eEr �r <br /> CI7Y STATE ZIP <br /> OWN�R PHON�: ��,-�j � OWN�R EMAI�: �--�-�"� <br /> CON717ACT01�NAMe: '� S� � "� <br /> CONTRACTORADDRE88: srRe�r �"I S <br /> crrr �Q � � srn� zm ` <br /> cONTR�AcTOR PwoIV�: ��s CONTRACTOR EMAIL: '��UY� �T S �"LlJ .�.'Svl . <br /> CONTRACTOR LICENSE#(l2�QUlRED): � V r I �G Q17Y OF EVPRETT BU61A]E6S LICENSE#(REf1UI1�D) ��'� <br /> pRIA1lARY CON7qC7� ❑OWNER CONTFtF1CTOR C7 07H�R(Pleaee SpoC�t�) <br /> CONTACT NAME: CONTAC7 i'HONE; C.�� <br /> Kf�"� ��t� �/� CONTACT EMAIL: ��,�-}-5 �� ..�-�� �j�/� <br /> �rlILDlhIG PlRIVII'P APPLICATION <br /> � �xlstin lJse oP Bulldin : Contract Priae of 1Norlc::6 � <br /> Pro ased Use of Buildin : HeAt Source� C]Gas leclrlc DOlher " <br /> Bulldl� T e' FR-Dotachecl OSFR�Atteched ❑Du iex ❑MUIf!-F'amil -1`�of Units: ❑COr►Imerafal ❑Industrlaf <br /> r e cr Proeot� t7uew ❑AddIlion ❑Remodel Re�efr OT,I, ❑Sf n C�S rinkleP aVemolltion ClChang�of Use <br /> 17�SCRIPi'fON oF WORK: <br /> ��rn D�� � �e.���C� �I eC��' i � w o��-� �l �G�-t� <br /> AssOCIAT�D 6UfRAfNG A�RMIT� It e Ilcable; <br /> IV�tQHANIC/AL P�RM1T APPLICATION ALUMB�NG PCRMIT APPLICATION <br /> Type of Pr Q r Naw Add� �ltsratlon _,Rapa�r lypo af ProJect: Naw �ddn Altsrat{on Repalr ' <br /> F�M°es �Ist'of Fl�ures H�uy� Y�of � #of � <br /> Gfst o lx�ures �xtures Llst o�Flxturws F��ures Llst of Flxwres i <br /> AIC-Alr Handlln Unita H um Tauet Backflow f'rev�nter Inslde Bldg I <br /> �i, Forcecl AU S stems nft hleator Sathtub Urina! <br /> T Gae P{ In Solfar Lavato Wash Bqsln Drfnkln Founteln I <br /> Waler Heater RoErl eretlon 5howar Ftoor Draln ; <br /> oas Flre fsce Ullood Stove Kltch�n 31nk&Dla oaal arease Tra � <br /> Oae Ran a atln Dlehwaeher RooF Dralne � <br /> lolha�D er M a Ot r' Clothea Washer . Medlcal Oas i <br /> Rqn Water Hoater Ofhar: � <br /> Exhaust Fan Sink serVlcelBarlMo /atc. Olher: <br /> SPR1N �SSI� M � <br /> em[cal or ,ot Weads ' <br /> ACKNOWLEDGEM�NT-�1 heve rsv(ewed fh/s eppllcaUon end���m t8a Inrom�aflon oonfalnad�eraln Is��ue and conec�,Wwk done puneuant to rhls permlt must comply w/tP� <br /> a��anl faderal,sfat�entllacallaw.Th��renfing of�perm/f only eulhw7zes epproved work and no Uav1a1lons�Rar�lrom.Devlatlons mus!//rst Ae aufhatzad In wrfling/rom fhe <br /> eu!la1n�OHlc�el ba►are baing eulhorized underany chcumslenca 1 am fhe owner,or•1 em eufhorized by Ihe owner oP fhJa praparly!o pe�larm fha woNc for whlcA epp!lcefkn(a made, <br /> end I comply witn(Ao Slafa Con(�actors Law 90.27 RCW anq zaa200A WAC. <br /> c�y of Eve,�rr oNielar use onry <br /> � � � � � � P�ar�ir� �C � ) � ' , <br /> ' v ; ✓� <br /> Own uthorze Ag Slgnature pate Revse 9 ) � <br />