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12/01/2017 FRI 9: 25 FAX Fast witer Heater U003/007 <br /> 6ll5D - <br /> PERMIT <br /> APPLICATION <br /> el,t.—A/--- BUILDING I MECHANICAL.I PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-81310 I FAX 426-267-8857 I(E)everetfeps@everetlwa.gov I www.isvereliwa.gov/perrnfte ' <br /> Blue or Black Ink Onll Please PROJECT SITE INFORMATION , <br /> PROJECT SITE ADDRESS: 1 a&5- 5 PJ' 3-� _ PROPERTY TAX#:(Z11,33,33 i 00 IP A V <br /> LEGAL for new construollon: Short Plet/aubdivlelon Lot No.__ (attach copy of long legal description) d) <br /> CONTACT INFORMATION <br /> OWNER NAME: V f telttit- 014' TENANT NAME(If Commercial): 9P c—� <br /> OWNER MAILING ADDRESS: srsaeT f0 I /1 S 3 �J <br /> Cow �/II LSTATE W4' o 3 <br /> OWNER PHONE:L5391 .l'1 OWNER EMAIL: — l <br /> CONTRACTOR NAMI~: rpt S1_ 1n 1 !� .L T . <br /> CONTRACTOR ADDRESS: • STREET ‘a N Nes_ c) { S : G I Q(49 <br /> ow 56 a`NI 1,,-1— area: j A. zIPI NI-VA-. <br /> l 1 <br /> CONTRACTOR PHONE: — 2 5 , 0 r yCONTRACTOR EMAIL: . C.vn ��S f I -ruJ/jqt✓ V�/ 45'3 I- ^3. .AA <br /> • CONTRACTOR LICENSE#(REQUIRED):VrSrt'WI )\t 13(---,rj� CITY OF EVERETT BUSINESS S LICENSE# `1(REQUIRED) <br /> PRIMARY CONTACT: 1 I OWNER (CONTRACTOR ID OTHER(Please Specify).._____.. _ , <br /> CONTACT NAME: /� CONTACT PHONE: "_I p.5- ' A__e �. <br /> K' � A � CONTACT EMAIL: p_vv'\rft cam► wlA- tyre rel . t^/o�1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: r-le Contract Price of Work:S, � ,Zr5 __ .r.. <br /> Proposed Use of Building; SFR., . Heat Source? OGas ( Llectrlc ❑Other _ ^ <br /> BuildingFR-Detaohed ❑SFR-Attached ❑Du lex OMuItl- -# <br /> Famll of Units' OCommercial ©Industrial ^ <br /> �Pe: S� P Y' <br /> Type of Project: L1New LIAdditlon ORemodel Repair ❑T.1. CI sign 'OSprinkler ❑demolition DChange of Use <br /> DESCRIPTION OF WORK: ' <br /> . vin 0\J' l reel?\A.0 _6.kc r tG ak- V\c a,- <br /> ASSOCIATED EUFLDING PERMIT#(If epplioableL <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New ,Addn . -.Alteration _Repair <br /> #of Liat of Fixturea #of List of urea #of hist of Fixtures #of List of Fixtures ^ <br /> Fixtures F►xturea Flxtur_9ea Fixtures <br /> C—Alr Ting Unite H uri p . 'Toilet Baokfow Preventer(Inside 81dg) <br /> Forcad Alr Syet nit Heater _ _Bathtub Urinal <br /> ` Gas Piping Boiler_ Lavatory(WhasBasin) DrinlFountain�_ —__ <br /> Water Heater - - Refrigeration `Shower Floor Drain <br /> Gsa Firs,lace - 6, Wood Stove Kitchen Sink&Die•oesl Grease Tra• <br /> Gee Ra e o Allikk Ductin• Dlshwas sr Roo Drains <br /> lothes D7Ho pa Other: go Clothes Washer _ Medical Gas <br /> ll.••e Ho Water Heater _ Other: _ <br /> Exhaust i-an Sink(Servtce/Bar/Mop/eto.) Other: <br /> _ <br /> SPBIN �lI RSSIO TaM .� __ . _ <br /> (eiemloel or W 1 .of Heade - <br /> ACKNOW EEDOFM.N1 I have reviewed this application and confirm the information contained herein fa true and correct.Work done pursuant to this permit must comply with <br /> current federal,aisle,end local law.The granting of a permit only authorizes approved work end no deviations therefrom-Devlattons rrrust And be authorized in writing nom the <br /> Building Official before being authorized under any circumstance.I ant the owner:ort em authorized by the owner of this properly to perform the work for which application Is made, <br /> and 1 comply with the Stets ContractOra Law 18.27 RCW and 200.200A WAG. <br /> Lx <br /> City or Everett OMNI Use Only <br /> �cA <br /> ~� vy `j �f�� 1 , PERMIT IA �IL� l/Q�a <br /> Own uthor hrr Signature Date (RaVised g%21101464 <br />