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11/21/2017 TUE 11: 43 FAX Fast Water Heater U003/008 <br /> 'N) 5 3 3 <br /> PERMIT APPLICATION <br /> r BUILDING I MECHANICAL I PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)421-3-257-8910 I FAX 425257.8857 I(E)everetteps@everellwa.gov I www.evereltwa.gov/prvrmlls y <br /> (Blue or Black Ink Only Plea <br /> r'se PROJECT SITE INFORMATION 2 <br /> PROJECT SITE ADDRESS: ,' 2 D ST PROPERTY TAX#:115 - 0 ,. t1^ 303 - <br /> LEGAL for new construction: Snort Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> • <br /> OWNER NAME: 11,4 ° q,(4 Ph cGCI F' TENANT NAME(If Commercial): �— <br /> OWNER MAILING ADDRESS: sia6Er ),32-3 q i!R'1) ST SL -- <br /> CITY -I/ (fWA't STATE VA. 21P q 6l" - <br /> '2\121'27_2i'ONE; l,c ? 'OWNER EMAIL: <br /> CONTRACTOR NAME jCP\ST W Ai K t'1-e-pfT /L2._ <br /> CONTRACTOR ADDRESS: SrREEr 11-'y5- (Au_ )q $ 4 nr�C , 1) cg-c)1 `` <br /> Cnl 0 V liI✓ STATS I�h z.p a `1 <br /> CONTRACTOR PHONE: (-'[rr 5 _Q 3.1:---)`6`-/1 CONTRACTOR EMAIL:E z a 5 (�- '1S1-u)Ok1f.)(Ima , co/ <br /> CONTRACTOR LICENSE#(REQUIRED)_ 1–kA}/0 0(7Lls\ 5I✓ CITY OF EVERETT BUSINESS LICENSE ti(REQUIRED)5D L15 <br /> PRIMARY CONTACT: ❑ OWNER ( SONTRACTOR ©OTHER(Please Specify) <br /> CONTACT NAME: /� �/ I CONTACT PHONE: Lf a 5 � "3j S1--/t <br /> KY�� 1\��u' _ CONTACT EMAIL: Q�I� I C �A-\-e`''\ Ep g/Y-I�/', -�/I/I <br /> BUILDING PERMIT APPLICATION l�� <br /> y <br /> Existing We of Building: 5f k Contract Price of Work:$ <br /> 3'� Proposed Use of Building: 5 Heat Source: IiIGes agliectrIc ©Other <br /> Building Type: AFR-Detached ©SFR-Attaohed ❑Duplex ©Multl-Famliy.#of Units: )Commercial ©Industrial <br /> Type of Project: °New fAddltlan DRemodel hiRepair LI T.I. E7Sign ❑Sprinkler ❑DemolltIon fChange of Use <br /> DESCRIPTION CP WORK: <br /> f--tW) D\l'e / re UP\ Ce dveLtrl: C/ U\-)' 'k-e)‘r V\ C a,"ter <br /> ASSOCIATED BUILDING PERMIT#S(f applloadle): A <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERIVIIT APPLICATION <br /> Type of Prefect: New Addn _Alteration Repnit Type of Project; New _Mdn _Alteration - Repair <br /> #of #A of #of if of <br /> List of Klxturvs List of Fl ures L/st of Ftxturea [jot of Fixtures <br /> Fixtures Fixtures Fixtu_r_es _ Fixtures <br /> A/C—A J • _ • •Its H®et P. Tp Toilet Backflow PreventerjLnolde Bldp)- _ <br /> - <br /> F. ad Air Systems Ur Heater _ Bathtub Urinal <br /> ` rw Piping _ roller Lavatory(Wash Basin) Drinking Fountain. _ <br /> Water Heater L Refrl•eration Shower Floor Drelo <br /> Gee Fireplace cod Stove _ Kitchen Sink& Disposal Grease Trap <br /> Gas Range- DuqL. Dishwasher Roof Dralne <br /> Clothes Dryer Hool a Other: - J Clothes Washes' . Medical Gas Range Hood Water Heater Other: _ <br /> \ ,,ExhauBt F Sink(Service/Bar/Mop/eta) Other: - <br /> BPRINNA.1 EISSIO IVI <br /> if rnk al or Water...,------ .of Heads <br /> ACKNOWLEDGEN4N7 I have reviewed this application end confirm the Informellon contained herein is(roe and correct. Work done pursuent to In permit must comply with <br /> currant rederal stair;,end Meal 1.8w.The grentintt of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the <br /> Bulla ng Officio!before being authorized under any circumstance.I am the owner, or/em authorized by the owner of this properly to perform the work for which application la made, <br /> and I comply with the Stale Contractors Caw 18.27 ROW end 298200A WAG. <br /> I (P1- <br /> City of Everetttt Offic/iall Use Only <br /> li lik, / c\;L Jb 1 `� I t <br /> PERMIT n1 1-0-1 1 <br /> Own=r -uthorise�Agbry�SIgnaiure Date (Revised 9/2:341bi9) <br />