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Mm PERMIT APPLICATIOit
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<br /> BUILDING I MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION
<br /> EVECITY OF EVERETT PERMIT SERVICESRETT y 3200 CEDAR STREET,EVERETT,WA 982O1 '
<br /> wAs HINgroN (P)425-237-8810 I FAX 425-257-8857 I(E)everetteps@everettwt,,gov I www,everettwa,gov/permits
<br /> *hila or BIa k-hlk'OYdly'Pte ie { " `r 'PROJECT SITE . ,ATI _ ,kx' , . .' , , t
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<br /> PROJECT SITE ADDRESS: 4932 DOVER ST PROPERTY TAX#:00733800000600
<br /> LEGAL for new construction; Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: CAL JOHNSON TENANT BUSINESS NAME(Commercial):
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<br /> OWNER MAILING ADDRESS: sTReer 4931 DOVER ST
<br /> crry EVERETT 9TATG WA zip 98203
<br /> OWNER PHONE:509-280-6735 OWNER EMAIL:
<br /> CONTRACTOR NAME: WASHINGTON WATER HEATERS
<br /> CONTRACTOR AODC ss: trine/. 17152 116TH AVE SE
<br /> ens RENTON swe WA ZIP 98068
<br /> CONTRACTOR PHONE:4255-883-4871 CONTRACTOR EMAIL: WAWAHVAC c@GMAIL.COM
<br /> CONTRACTOR LICENSE#(REQUIRED):WASHI I*9800F' I1ry OF EVERT TT BUSINESS LICENSE#(REQUIRCD): 053449
<br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-883-4871
<br /> JA CI DANIELS CONTACT EMAIL: WAWAHVAC@GMAIL,COM
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<br /> Existing Use of Building: RESIDENTIAL ,Contract Price of Work:Work:$1800
<br /> Proeosed Use of Building: Heat Source: 9Gas ❑Electric OOther
<br /> BUILDING USE: DSFR ETownhouse EDu.ex DADU EMuki-Famit -#Units ECotnmerclal EAccesse Str . e
<br /> f Icrefact: DNow ladtlitlott ERem daI 0Repair I T.I, :St) DSprinkler,. ECemolition EChsn o cif U F //r/ 1��It
<br /> DESCRIPTION OF WORK:
<br /> REMOVE& REPLACE 1 GAS WATER HEATER
<br /> ASSOCIATED BUILDING PERMIT#(If applicable): + jy
<br /> 7 1 !, k "`'! {� titooA a ANS r n ° �, ` w�,�o+c. ' y' .,,
<br /> 4.,.,` A'. . M ; iUMB E i' ` J3 AtION
<br /> Fixture Llel at Ffxtur r tufo Fixture Fixture !P
<br /> Count Count List of Fixtures Count List of Fixtures Count List of PlxLurr
<br /> NC-Air HandlingUnits .Gas Piping Hackflow Preventer(inside Bldg) shower,Tub,or Combo
<br /> Boiler Gas Ran.. Clothes Washer Sink-Commercial 3-comp,prep,floor
<br /> Clothes er Heat Pump&Duciless Dishwasher Sink-ResIdential(kitchen,hath,bar)
<br /> Duct System(Remodel Refrigeration Drrnkint Fountain Sink-Utilit ,laundr ,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb �Urinet
<br /> Exh ust Hood(Type n) 1 Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interoe.tor-Sand/Oil Water Service behind meter)
<br /> Forced Air Systems Other: Medical Gas Wets gives or Fixtures
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<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> i. I;I,SilOROLE-.A1SU`PpR Stl6N YS iSewage Ejector or Sump Pump Other.
<br /> Water-uppressien System No.of Roos
<br /> Chemical uppression S.221:1) 1o.o cads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,state,and local law.The granting of a permit only authorizes approved work find no deviations therefmrn.Deviations must first be authorized in writing from the
<br /> Surkdfrt(Officio/before being authorized tinder any circum ca.I ant the owner,or I em authorised by the owner of this meetly to perform the work for which application is made,
<br /> end I amply with the State Contractors Law 98.27 RCW 298,2OOA 100,
<br /> ----.. City of Everett Official Use Only
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<br /> . .� 12112P19.......nature Agent&Owner/Authorized Ar
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<br /> +� a gate (Revised fGt 1iv2ti're)
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