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PERMIT APPLICAT"11I
<br /> BUILD,,..., / MECHANICAL / PLUMBING / SIC:: : SPRINKLER/ DEMOLITION
<br /> EVECITY OF EVERETT PERMIT SERVICESRETT y 3200 CEDAR STREET, EVERETT,WA 88201
<br /> WASHiNeroN (P)425-257-3810 I FAX425-257-8867 I(E)everetteps@everettwa.gov I www.everettwa-gov/permits
<br /> (R u� or Bi Ek Wink OnII'PIa i lbs• ":� i; `:P1t.JECr I `E` I O OI€MA`ION ; .4 r; 5 ?
<br /> PROJECT SITE ADDRESS: 4710 ELM ST PROPERTY TAX#: 0053640000801
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> 4i, „II {� i„>w,, rid an rr li
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<br /> OWNER NAME; HAAG, NANCY TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STRE=T471 ELM ST
<br /> cn- EVE RETT STATE WA 2iP 98203 ,'...._
<br /> OWNER PHONE: 808-281-3600 OWNER EMAIL:
<br /> CONTRACTOR NAME:WASHINGTON WATER HEATERS
<br /> CONTRACTOR ADDRESS: STREET17152 116TH AVE SE,'0 BOX 59208 .
<br /> CITY RENTON STATE WA zip 98058
<br /> CONTRACTOR PHONE: 425-883-4871 CONTRACTOR EMAIL: WAWAHVAC@GMAIL.COM _
<br /> CONTRACTOR LICENSE#(REQUIRED):WASH I I*981 O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 053448
<br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:,JACOI DANIELS
<br /> JACC I DANIELS CONTACT EMAIL:VUAWAHVAC@GMAIL"COM
<br /> Existing Use of Building: RESIDENTIAL Contract Price of Work; $ 1100
<br /> Proposed Use of Building: Heat Source: I]Gas ElElectric DOther
<br /> BUILDING USE: [SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accesso Str , lire
<br /> ape of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Wei/{f1,
<br /> DESCRIPTION OF WORK: _.
<br /> REMOVE&REPLACE 1 ELECTRIC WATER HEATER
<br /> ASSOCIATED BUILDING PERMIT#(if ap.licable :
<br /> ��tlLTy MrE 7:s+GzS I 1'.Ti ,l � ,,� y 'f;-.,,yy,e...:., ..:'•• '1.., .au vltN „ iiR:,ij; c0I1140.0 - ' I l►.
<br /> i� 4,
<br /> . d,g.;;
<br /> Fixture List of Fixtures Fixture Fixture Fixture
<br /> List of Fixtures
<br /> Count count List of Fixtures Count List of fixtures Count
<br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range _ Clothes Washer Sink-Commercial(3•comp,prep,floc
<br /> Clothes Dryer Heat Pump&Ductless ,Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink•Utility,laundry, mop
<br /> Exhaust Fans(Residential) Commercial Ventllatlor- Floor Drain Toilet
<br /> Exhaust Hood(Type I (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease WesteNVater Piping Repair
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<br /> Exhaust Hood(Residential) Wood Stove 'Interceptor-Sand/011 Water Service(behind meter)
<br /> Forced Air Systems Other; Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains 1 Water Heater
<br /> ' ,,..„.IS.1: SU RESSIONS STE�Ilry ,, Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads ''
<br /> Chemical Suppression System No.of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein is true and correct, Work done pursuant to this permit must comply with
<br /> current federal,state,and/oss!law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Bullding Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and!comply with the State Contractors Law 18.27 RCW a 256.200A WAG"
<br /> City of Everett Official Use Only
<br /> _96"61:
<br /> PERMIT —��
<br /> ( 614119 v � ' �
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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