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10/30/2017 MON 15: 03 FAX Fast h[fter Heater 1005/008 <br /> I 1 I 1 q <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLIYION <br /> CITY OF EVERETT PERMIT SERVICES <br /> a' • 3200 CEDAR STREET,EVERETT,WA 9x201 <br /> (P)425-257-8810 i FAX 42S-257-8857 I(E)everettepsc reverellwa.gov I www.everettwe.gov/permits <br /> (Blue or BIaGk Ink Only Please) PROJECT BITE INFORMATION . <br /> PROJECT SITE ADDRESS. 1025 L �,� 3 I P <br /> SROPERTY TAX#: U D 5 A._,...„; <br /> �OO <br /> � <br /> LEGAL for new construction: Short Plat/eubdfvlelon _ Lot No. (attaoh copy of long legal description) <br /> • <br /> CONTACT INFORMATION . <br /> OWNER NAME: ;C N lit n �1 r I 0 TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: 1 smear 10 e 5 ,O Si-- St/t) 3 I' • <br /> cm 6Ir'' 1 arm LA ZIP i rep tl <br /> OWNER PHONE: 495 , (i13- 3L-'1 , OWNER EMAIL: <br /> CONTRACTOR NAME iii ST 1 ,= I, 0- -.C1" ,.. <br /> CONTRACTOR ADDRESS: aT1 Eer `r114 �� N CX e ^'" (; 1 n <br /> CY !S0 srATE y � <br /> nZIP / i A 1 <br /> CONTRACTOR PHONE: '0 S ,,Q.�p'I-DV-A CONTRACTOR EMAIL:12 VYl IIS / , i'LUOC-r. !(cr. owl <br /> CONTRACTOR LICENSE#(REQUIRED):fa-S'-jI) & ' d, c JcITY OF EVERETT BUSINESS LICENSE#(REQUIRED)5D(453 <br /> PRIMARY CONTACT: El OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME; ^ CONTACT PHONE: L( Jo <br /> ' , -9`Ds-11 <br /> �'4j l I"k). CONTACT EMAIL: QP(Wt,ft � `L1�t�'" t „4,e,r, Wvi , <br /> BUILDING PERMIT APPLICATION _ <br /> Existing Use of Building: I 0 Contract Price of Work:$ _ �6 b9 • , <br /> `4.c " <br /> 3� PropoaedUse ofsullding: r _.._ _ Heat Source: ,te6ee ❑Electric nOthOr <br /> Building Type: OSFR-Detached ©SFR Attached I7Dupiex I=1 ulti-Family-#of Units: OCommerclal D1ndustrlal <br /> Type of Project: ❑New ©Addition DRemodel 1Resair ❑T.I.• ❑Sign OSprinkler ODemolltfon ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> vnn ov' ce/ Ye,p\iCi(1-S wa+‘.eir V\Ca-\ ' <br /> ASSOCIATED BUILDING_PERMIT#(If applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 1'ION <br /> Type of Protect: _New_ Addn „ Alteration _Repair Type of Project: _New Addn Alteration __Repair , <br /> ^Fixtures !!at of Fixtures t7xturea of #of <br /> Llai of Fixtures Fixtures `t of Fixtures f=ixtures List of Fixtu • <br /> A/C--Air Handling Unite Heal Pump _ Toilet Backflow Proven 24Inslde•Bldg <br /> . _ Forced Air Systems Unit Heater Bathtub Urinal <br /> N. D Gas Piping Boller_. Lavatory(Wash Basin Drinking Fo , :InWater Heater Refrigeration ~ Shower _Floor Dral Gas Fireplace Wood Steve Sink&Disposal Grego. rap <br /> - <br /> -Gas Range Ducting - • Ishwasher Roo •raine <br /> Clothes Dryer Hookups Other: lothes Washer v=dlcal'Gas - - <br /> Range Hood eter Heater a th <br /> Exhaust FanS k(Service/Bar/Mop/etc. Other: <br /> SP4tIN EIS-SUpP_ I,°SB10I $ll-6 M � - <br /> emloel orW .of Heads <br /> ACKNOWLEDOEMMNT:I have reviewed this application and confirm the Information contained herein is true and correct.Work done pursuant to INS permit must comply with <br /> current federal,slate,and local law.The granting of a permit only al thorizes approved work end no deviations themetin.Deviations most first be authortzedin writing from the <br /> Sul/ding Olins/befohs being authorized under any circumstance.I em the owner,ori em eutho,Ysad by the owner of this property to perform the work for which eppi'bation is made, <br /> end l comply with the State Contractors Law 10.27 RCW and 29d200A WAC. <br /> Olty of Everett Official Use Only <br /> lb • 3 D • I PERMt1Y�V/1I' I I D" Ob_ <br /> Own uther zeJ)\jJQj1iL <br /> gnature Date (Revised 9/23/2010 <br />