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PERMIT APPLICATIO
<br /> BUILDING/ MI=CHANICAt./ PLUMBING /SIGN/SPRINKLER!DEMOLITION
<br /> EVECITY OF EVERETT PERMIT SERVICESRETT Y 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASWINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS:2025 E Grand Ave PROPERTY TAX#:00563245700301
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> C01NiT.4CY �1(lF0,1tllfh{�,'�I"10!4 'f ,
<br /> OWNER NAME: Cheryl Dunn TENANT BUSINESS NAME(Commercial)'
<br /> OWNER MAILING ADDRESS: sTlrssr2025 E Grand AVe
<br /> cmv Everett STATE WA tip 95201
<br /> OWNER PHONE: 1-1,7_ --31.4— Ce 7.._ OWNER EMAIL:
<br /> CONTRACTOR NAME:Washington Water Heaters
<br /> CONTRACTOR ADDRESS: sTee17152 116th Ave SE
<br /> cRenton
<br /> m STATE WA ZIP 98058
<br /> CONTRACTOR PHONE:425-883-4871 CONTRACTOR EMAIL:WaWahvacgmail.corn
<br /> CONTRACTOR LICENSE#(REQHIRED):WASHII*9800P CITY OF EVERETT BUSINESS LICENSE#(REQUIRE4): 053449
<br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME; CONTACT PHONE:4.255-883-4871
<br /> Jacci Daniels CONTACT EMAIL:wawahvac@gmaiI,com
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<br /> Existing Use of Building:residential Contract Price of Work:$1000
<br /> Proposed Use of wilding: Heat Source: ElGas ❑Electric 0Othe3'
<br /> BUILDING USE: I]SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Struriric
<br /> Tree of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use� i1eril4
<br /> DESCRIPTION OF WORK: Rempve&Replace 1 Gas Water Heaters
<br /> ASSOCIATED BUILDING PERMIT#`f applicable);
<br /> 7:77i s:
<br /> ` EGli i '` ERM APPLIAT„Ly� y i f,,,l,n1, ,F r a�PUv BiN , M t1 . i
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<br /> Future Fixture Fixture
<br /> count List of Fixtures count List of Fixtures Count List of Fixtures Courft List of Fixtures
<br /> A/C-Air Handling Units Gas Piping Backflow Preventer(inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kltchen,bath,ber)
<br /> DuOt System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet
<br /> Exhaust Hood(Type i) (Not Haat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) __1 Water Heater Interceptor-Grease W Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/011 Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Sas Water Valves or Fixtures
<br /> ylyGas Fireplace/Insert/Log Roof brains Water Heater
<br /> {'t1 ar f'� , r.t
<br /> 11 - a” II � --
<br /> ,. .t,r r,u°rL r � i �', .r ?k'; Sewage Ejector or Sump Pump Other;
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System -No-of Heads _
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true end correct. Work done pursuant to th/s permit must comply with
<br /> current federal,state,and local law.The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being authorized under any of stance.I am the owner,or I am authorized by the Owner of this property to perform the work for which application is made,
<br /> and 1 comply with the State Contractor Law 18.27 R and 296.2004 WAC.
<br /> 4w/cog City of Everett Official Use Only
<br /> PERMIT#
<br /> 1011119 AA ( g i 61-0 3q ____j
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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