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Feb 24 2017 01:45PM Washington Water Heaters 8663757454 page 4 <br /> PERMIT APPLICATION <br /> 4e77 BUILDING I MECHANICAL/PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET.EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 i(E)everetleps@everetiwa.gov i www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:b195 7715t-A&- Jl PROPERTYTAX#: <br /> LEGAL for rew construction: Short Platlsubdivision _Lot No._ (attacri copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Gj At-r—,51 <br /> Cr7Y Ute• STATE W Z!P <br /> OWNER PHONE: 31 f 3-] OWNER EMAIL: <br /> CONTRACTOR NAME: UJ�S �tiGIT�Nyj& 6ji /q7&?j <br /> CONTRACTOR ADDRESS: STREET (i JZ— j i F6 (}x <br /> CITY �tT UI 1 ✓�' SATE ���/Gv 0 zea <br /> CONTRACTOR PHONE: 426- - CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): Wl r �� CITY OF EVERETT BUSINESS LICENSE#(REQUIRIi r <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT i I CONTACT PHONE: �G.-� 3_7g7/ <br /> CONTACT EMAIL; <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building; Contract Price of Work;$ <br /> Proposed Use of Bufidin Heat Source: ©Gas ectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0Du lex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair 11. ❑Sign ❑S rinkfer ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPpipATION <br /> Type of Project: New Addn Alteration Repair Type of Project: New iGntain <br /> Repair <br /> rF of � — �List of Fixtures #of #of Fixtures Fixtures List of Fixtures List of Flxrures st of Fixtures <br /> Fixtures FIC-Air Handlin Units Heat Pump Toilet eventer(Inside Pi <br /> Forced Air Systems Unit Heater Bathtub Gas Piping Soifer Lavato (Wash Basin) <br /> Water Heater Refrigeration Shower Floor Draln <br /> Gas Fireplace Wood Stove lKitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar,rMoo/etc.) Other: <br /> SPRINKLER ) SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENTt have reviewed this application and confirm the information conteined herein is true and correc!.Work done Pursuant to this <br /> current federat,state,and focal law The P permit must comply with <br /> granting of a permit a ty authorizes approved work and no deviations therefrom.Deviations must First be authorized in writing from the <br /> Buiktrng Official before being authorized under any crrcumstance am the owner,or I am aufhorizad by the owner of this property to perform the wodr for which application is made, <br /> an omply with the State Contractors Law 1 7 RCW and 2 .206A WAC. <br /> /i City of Everett Official use Only <br /> t Uq r?"' �/ 7 PER T <br /> wneriAuthorized Agent Signature Date <br /> (Revised 5/20/x016) <br />