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O1/p3/201g wEo 12: 21 FAx Fa�t water Heater f�003/012 <br /> �VV��V <br /> ��Ftl1lll7'APP�ICA�IOf� <br /> BUILpiRI� /MECHANIC,AL I I'LUMF3ING/S1GN/SPRl�1K�.ER/ DEMOL,lT10N <br /> CITY OF EVERE7T P�RM17 SERVECCS <br /> 320fl GF_pAR STREkT,�V�R�'f"I',WA 99201 <br /> (P)425-257-8610 � �AX 426-267-8857 �(�)everelte�s@everellwa.gov� www.everellwn.pov/permft� • <br /> �lu�or��aa1t lank �nl �l�gse PFtO.DeCF SiTe INF�l2M6#Y��IVI <br /> PROJECT 91TElaDDRES3: � PROPERTY TAX#: D� ' �D � <br /> L,�GqI,For naw cona[rucHvn: Short PIaF/auUdlvlelon Lot No,�`_ (attach copy vf Iong fegal daecrfpNan) <br /> COP+ITACY IN�OF2IV�AT10�1 <br /> OWN�R NAME: � l;"]U ��/ TENANT NAME(lf GommerCl�l): �— <br /> OWN�R MAILlNG ApDR�SS: srH�Er a �— <br /> orrv srazc zm O� <br /> OWN�Fi PHON�: � 5 I p� OWN�R EMAIL: <br /> CON7{2AC701�NAM�: "� �`r <br /> CONTRqCTOR A�1DR�SS; sTREET � S � <br /> ��,� � � � srA� z�� 1 <br /> CONTIZAGT01�PWOiV�: �-'��S CONTRACTOR EMAlL: Q,IrVI IT S �"V�J �. <br /> COhITRACTOR LICENSE#(R�QUfR�D): S � �j� CITY OF EV�RETT eU61NE6S LICENS�Jl(13�QUIR�D)' "!�3 <br /> PRIMARY GONTACT: ❑ OWNER CONTRACTDi� O OTHER(Pfes89 SpBClfy) _ <br /> CONTACT NAME: CON7AC7 Pf'fON�: �-f p�'S <br /> I�r"-'� �s�l � v� CONTACTEMAIL: �y1J�,I��S VJQ�. V "��� vVv+�l <br /> �U1LDy[�O P�RMI'1'�APPLICATIDN <br /> `! �xistln Use aF 8ulldin : C Contract Prlc�o�Work:$ � <br /> ��. <br /> i�rv osed Uso of Sulfdfn : S Neat Souroe: Gas C7Electrlc ❑Other � <br /> Bwldtn T e; ❑S�R-Detached �R-Attoched ❑Du lex ❑Multt-Famil �of Unite: C1CommerGal Dlndustrial <br /> e of Pro�ct: ONew I�Addltion ❑I�errladel Re afr CIT_I. OSf n �5 rinklar ❑Demolltlon �7Chsn e of Use <br /> DE9CR1PTfOTi OF WORK: <br /> �� oU� � �e,p1�.�� C�}- S �o�:�-��r �n �a,fi� <br /> ASSQCIATED BU1LDfN0 PLRMIT# If a lic�ble: <br /> MECHAN�C.A�L�L.'RIVII'Y'Ai�p�.�CA�'�ON PLUMS�NO Pf�RIV11Y APP�ICATION <br /> Type Of ProfOCf: ��VBW Addn �lleratfan _Repalr Type of�roJect: `Naw _}lddn �Itaratlon �Rapeir <br /> ��f Lfsf'oPPfxturas '��� �tBt of F/xturas #Of �/sf of Ffxtures �°f Llst of Flxtulee � <br /> F1xtu�as F/xt�ras Flx�ures Flxturos I <br /> Ia1C—Alr Flandlln Un►ts Heat Pum 7'ailef oackf�ow Prav nter Inelde gld <br /> � Forced Afr S stems Unit M�alar Sathi Urtnal ! <br /> ` Gae Pl fn �3ollar Lav Eo W�sh Basln Drinkln ounfaln � <br /> Wator Heater aefrf eratlon 5 ower loo raln , <br /> Gas Flre f�ce V1lood StovB KI hen Slnk&D1� oeal G ra � <br /> oae Ran e Duating nl hwasher oof Dra�ns <br /> Clotl�os D er Hooku s Oth�r' CI thes Wesher Nledloal Cyae � <br /> f{�rt e Mood Wa er Heater Ofhor: � <br /> F�cheuat Fan Slnk 5e111ia9/8&t/MO Othor: <br /> �SpRIN ��S�O M ' <br /> emlaal or W .of Heade ' <br /> ACKNOWCPDaEM.f�N7"��h�v�ravlawaU thls eppllcatlon and conNrm�he Infarmmlron aa»talned Nereln Is Irue and correcl. Work done pursuent ro thls permlt muef comply wlfh <br /> currenl/ederal,sfet�;antl locsl law.T1f�granNng of a psrrnit only euthodzes epproved work end no tlavle�lons 1Here2om,OevlaUons musl/lrsf be�ufhorfi�d!n wrlfing t}am fhe <br /> Bulltllnp ONiolel beMre being�ulhorlied underany clrcum8tance,!em tho owirer,a�-I sm aufhoNzed by tho oyrnerof fhls proper(y lo perf�orm tha work for wHlch apv�lcaflon!s n�ade, <br /> end I comply w!!A fH6 5[ate Confroofols LE1w 7@.27 RCW ar�d 2VQZQ0A WAC <br /> CI1y of Everetf Ofl7clel Use On4+ <br /> ( - 3 - l g P��.� b -- <br /> Own u�hor ze Ag Signature Date (Revlsed 9/2:a/?016) <br /> -.....�_._.W.......V,...� '�.�._._.r. - - <br />