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09/05/2017 TUE 12: 05 FAx Fd�t water Heater f�009/005 <br /> — .�_�.».—�.,....__–r-....-.. .. .�.�_ -� �--_,,:.,,..._..- � _,----_.�._.�.�_,..._._ _ _ -_- <br /> • PERMIl"APP�.ICqTIOiV �O ���f <br /> BUILDINCy I M�CHd1NICAL/pLUMBIMG /SIGIU/SpRiN4CL.�R/ DEMOLITION <br /> G7Y OF EVCRE"fT I'�RMl1"SCRVICGS <br /> 32U0 C�DAR S7F2��'�,EVCR�TT,WA 98201 <br /> (P)426-267�8810 � FAX 423-257�5837 �(E)everelfeps�avafatlW&_gov� www.evoretlwe.gov/permfts • <br /> �1�a or Bl�ak InK O��Iy Ple�ae) PEtO�l�CT S�T� �INFORM,A'�NON <br /> PROJ�C7 fiIT�AppR�SS: D PROPERTY TAX#: ' O � <br /> L.�GAL.for now conslructlon: Snon PlaVsubU{vlslo Lot No. _ (aitach capy of long IBgal descriptlon} <br /> COINTACT INPORMATIOtV <br /> OWN�R NAME: L 7CNANT NAM�(If Commercial): <br /> OWN�R MIAII.ING AppI��SS: ern�Er <br /> CIIY BTATE 7Jp <br /> OWlV�R PHON�: OWNER EMAIL: �� <br /> CONTRACTOa NAM�: � S� � � <br /> CONTRACTOR ADDRESS: srqE�r �"� � =1�- <br /> ��„� a � � 9TA,� z�n � <br /> CONTRqCTOR PHON�= �d�s CONTRACTOR EMAIL: �,VY� I T S � �UJ ��. <br /> CONTRACTOR LICEI�tBE#�R�QUIR�D�: � � �jG C�7y OF EVPRFTT BLf91NEB8 LfCEPISE i�(REQUIRED) ��3 <br /> PRIMAI�Y CONTACT: ❑OWNER CONTRACTOR ❑O7H�R(P(ea8a SpeClfy) <br /> COi�lTACT NAME: C011TAC�PhtON�: �� <br /> �/�� ���v� CONTACTEMAIL: �w'���-� .�, G�/� <br /> �IIILDyNG PeRIVi1T APPLICATiON <br /> � �xl�tin Usa of Bulldfn ; Contract Prlce of Work:$ � <br /> Pro osed Use of Buildin : Heat SoUfCa: �lGa9 EfeGt�ic ❑Olher � <br /> BUlfdll� T e' SFR-Dotachad �SFR-Attochad ❑Du IeX OMuItl�Famil -#of Unita: QGommerclyl ���dustrial <br /> e Of Proect� CINew �Addltlon ORsmorlal R� afr ❑T.1. ❑Si 11 ❑5 �Inkfef ❑DemollElorl CICh�� e Of Use <br /> D�SCRIPTION OF WoRK: <br /> ��rn 0�� � ��2,�1��� �,�Q(;'�"r i G �ot.�-� � �Gt,�� � <br /> ASSOGIAl'�D 9UILDlNCti PERM[T# I�9 IIC�Ible� <br /> MeQHANICAL PeRM1T APPLICATION pLllNf�l1�C p�ItlYli7 APPLICATION <br /> Type oP PrvJvctr _Naw Addn ��1lteretlon �apalr 7ype vf ProJact: _,flew �Addn �Itaretfo� `�tepelr <br /> Flxturas �lsf oPFlx(ures ��u� Llat of Flxfu s Flxlures LIs[of Flxturv9 F/xtures ��sl otFlxturea � <br /> AIC--Alr Wandl nits Heal Pum Tollet B�cKflow Preventer Inelda 81d I <br /> y� Forcecf Afr S akams Unlf aler Sathtub Urinal ! <br /> �P` ae PI in ' B r L&vato W&bh Basln Drinkln Founteln I <br /> afer Heator efrl eratlon Shower Floor Drain <br /> cras Flce lace VUood Stove Kltch�n Sink&Dls osal �rease 7ra �� <br /> oae Rsn � Ductln Dfehwasher Roof Dr�lns � <br /> Clolhes D er Hooku e her: Clothee Washer Medloal Gas <br /> I <br /> n e Hood Wafer H�at�r Other: < <br /> ust Fan Sink SerVice/8aC/Mo eic. Other: • <br /> SPRIN �,'SSIO 1FS7'�M � <br /> emical or W ,of hieads ' <br /> ACKNOWLEDG�M�jVT'1 have rBvlewed thla eppqcatla�,�nd con/!rrn�n�!n(ama!(on rrontalaetl fiere/n/s frue elld correct,Warfc done puraifanf!o Hzls pem,lt must camply Wlth <br /> curren�lederal,afe19�B!!d lp6d11eW,rh@ pI@Illlll�0/a�]BfRi110R(y pU�ho�IZB9 eppfau@d Work 9nd rt0 Q9VlQtf077B MloIB4'01J1.06V1&flO116111U6t!1lSf AB 8(1fAor2Rtl l!7 WIlfll�g(ro7n fhe <br /> Hu!(ding 011Jclel bel6N b8A1g eulhodsed und9r any ch'cumsfancB,14m fhe owner qr I am e�lfhwrzed by!ha oNrner oP fhls propa�y!o peifolm fhe wodc for whlch app110A(!on fs made, <br /> ond I aompry wrlff(ha 9�ere Contrectors�ew 9�2 r RCW and 298�200A WAG <br /> ciry or Eve,�a orr���e�we onry <br /> /�J � P�R Y — O� f <br /> � <br /> Own ufharz9 Ag SlgndLure Date Revsed ZO � <br />