Laserfiche WebLink
03/14/2018 WED 15: 46 FAx 425 415 6867 Fast water Heater 0002/002 <br /> ?'11151 <br /> PERMIT APPLICATION <br /> lrBUILDING/MECHANICAL/ PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> 1. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 9B201 <br /> (P)425-257-8510 I FAX 425-257-8857 I(E)everettepseeverattwa.gov I www.everettwe.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION� � Sr� LS G 3 � PROPERTY TAX#: ©� D r DC) <br /> PROJECT SITE ADDRESS: �n <br /> LEGAL for new construction: Short Plat/subrilvlaiort, Lot No` _ (attach copy of tang Iegal description)44.4 Alimmwmommmimmilmmor <br /> ✓ <br /> CONTACT INFORMATION - <br /> OWNER NAME: i1A L a I 5 TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: smear Q' SE ' I <br /> CM ', All STAle v"'r 1 zrn IV, <br /> 3 - <br /> OWNER PHONE: IP)6 D 1j'( 0'-- OWNER EMAIL: <br /> CONTRACTOR NAME: '�A ST lid Al yZ. A • --A---k--. .g.... . <br /> CONTRACTOR ADDRESS; sTRedT \f11q.1 L ei N VY C Q,- PK-404 S 4 C D(p /�It�1 <br /> Crre Z Oft !/1,� STATE ZIP 1.1 ' <br /> CONTRACTOR PHONE: c--1 2 5 to"61. CONTRACTOR EMAIL:P.IZ.VY1 1T S ( -9,s,k-woes naa-Ivr, t,aYVl <br /> CONTRACTOR LICENSE#(REGWIRED):'f S-rw R BC lcrr OF EVERErr BUSINESS LICENSE ri(REAUIREO)50 L15 <br /> PRIMARY CONTACT: in OWNER ( CONTRACTOR in OTHER(Please Specify) <br /> CONTACT NAME: /� �/ �i 1 CONTACT PHONE: /'1 P5' ('3 L ID seil <br /> K>41 l�v"1 r v) (CONTACT EMAIL: {�"�jll ivt,11-6 _F&& i I'ie W r. c'vI/I <br /> T <br /> BUILDING PERMIT APPLICATION -. +7 p <br /> Existing Use of Building: Sr e m Contract Price of Work:$ L. l h " <br /> 1 .-.n <br /> Proposed Use of Building: $F t/M Heat Source;^ ❑Gas J iactrlc £JOther . _. . <br /> Building Type: ❑SFR-Detached ©SFR-Attached ❑Duplex Multi-Family-#of Units:_____ E1Commercial Dlndustrlal <br /> Type of Project: ONew ©Addition DRemodel I',:l Repair ❑T,I.• Osi$n USprinkler GDemoiltlon DChange of Use <br /> DESCRIPTION OF WORK: <br /> vin 0vC / re,v\ ct, -e (e cti- i c. ocA-e \A e at&r <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL PERMIT APPLICATIONPLUMBING PERMIT APPLICATION <br /> Type of ProjSCt; __,New" Acidn „riltteretron_Repair Type of Protect: _New _Addn _Alteration _Repair , <br /> Fixtures LiseosFixtures Flturfes List Fixtures Pbttu�nas List orOixtures Flit of <br /> List ofPlxturos <br /> —Alr Hand ;_Units Ha: 'um. Toilet Backflow Prevents!' Inside Bldg <br /> • Forced Air Systems it Heater Bathtub Urinal <br /> s Gas Piping Boller Lavatory(Wash_Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Flr place Wood Stove Kitchen Sink&Dlpoaal Grease Trac <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hook •ther: Clothes Washer•_ Medical Gas <br /> - <br /> Range Hood (.... --Water 1 ) Heater Other:Exhaust Fan Stnk jService/Bar/Mop/otc.) Other: <br /> �� . <br /> $PRIN EIFIE-ASURENEESIO A.i I i 4 <br /> emioal or W _of Flea•s <br /> ACKNOW=081,1e,•N7:I have reviewed fh/e application and confirm eh:Information contained herein is true end correct.Work clone pursuant to Ihls permit must comply with <br /> current federal,elate,end local law.The granting of a permit only authorizes approved worts and no devlationa tirorseMm.Da vlations must first Do authorized ki writing from the <br /> Building Official trefoie being aulhortzed under any circumstance.1 am the owner,ori em authorized by the owner of this property to perform the Work for which application Is made, <br /> and 1 comply with the State Contraotort Law 98.27 RCW end 29d200A WAG <br /> Oily ofEver tt Official Use Only <br /> iA ' it....... ...... I ( 4 I ; FERMI 1�� 016 <br /> Own y •uthorZs;Agr Signature Date ! (Revised 0/23/2018) <br />