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Oct 10 2017 12:38PM Washington Water Heaters 8663757454 page 1 <br /> grrPERMIT APPLICATION <br /> BUILDING/ MECHANICAL 1 PLUMBING !SIGN 1 SPRINKLER! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everetIwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION 2 <br /> PROJECT S1TE ADDRESS: 6116 X50'' 5-1- S6- +G1/' PROPERTY TAX#: 0b 7 3?.ao 3 qpt <br /> LEGAL fo:new construction; Short Plat/subdivision Lot No. (attach copy of long legal description) . <br /> CONTACT INFORMATION <br /> OWNER NAME: t,) fei 4( 6 iLtvi TENANT NAME(If Cormmerclal): <br /> OWNER MAILING ADDRESS: STREET LE -10 5+' 56- C / �y� <br /> CITY T J v�t l.. STATE J,t JFt ZIP 9�f <br /> OWNER PHONE: 1 1qc—6 't,L13 OWNER <br /> EMAIL:• <br /> • <br /> C V" <br /> CONTRACTOR NAME: (4)11-9t11UG1T-)N 1/0 4-7-- 11._ AH 7 1 q �} <br /> CONTRACTOR ADDRESS: STREET 1115 2_ a�{,/ 77"VC. — P6 ,SOX J92t b <br /> CITY p eA.Por i STATE berA ZIP qg5e <br /> CONTRACTOR PHONE: 4ZI3- Ye7I b! CONTRACTOR EMAIL: WA-GuMKfiG C�6�4ILI aim <br /> CONTRACTOR LICENSE#(REQUIRED): wn- gSt(Op CITY OF EVERETT BUSINESS LICENSE#{REQUIRED): 05 396/1 <br /> PRIMARY CONTACT: 0 OWNER LONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME1CONTACT PHONE: r12 -Egg—C/ 7l <br /> ...,...41-co D1.1)#1,444-Ht <br /> j <br /> c -'u -c Is CONTACT EMAIL: G1)#1, 44- f L ti{_ 601-it.,um <br /> BUiLD L G PERMIT APPLICATION <br /> Existing Use of Building: W jrl / Contract Price of Work:$ <br /> Proposed Use of Building: / eat Source: OGas I:Electric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex NL Ili-Family-#of Units: I I:Commercial Dindustrial <br /> Type of Project: CINew 1:Addition ©Remodel ©Repair DT.I. DSign i:Sprinkller i:Demolition UChange of Use <br /> DESCRIPTION OF <br /> P/GtittOkk_ 4-4-4t. <br /> ar 4- i _{ _ I ,�k Li r i {„/ ,/J(gi,Y'l/y r `C u <br /> c(30 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New T, Addn Alteration Repair Type of Project: New _Addn _ Alteration Repair <br /> #°f List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Rxtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Healer Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas FireplaceWoad Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Quoting - Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood 1 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> Number of Heads <br /> /ACKNOWLEDGEMENT".•I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this pemtft must comply with <br /> current federal,stale,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authored in writing from the <br /> Building Official before being authorized under any circumstance. am the owner,or t am authorized by the owner of this property to perform the work for which application is made, <br /> .y with the Stale Contractors Law 18.27 RCW and OA WAC. <br /> lCity of Everett OffkaiafUse Only <br /> (..itAl i ) /0 12 <br /> [PERMIT# I <br /> 0 , rIAuthorizad Agent Signature Date (Revised 5/20/2016) <br />