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Nov 14 16 12:20p <br />• <br />• <br />PERMlT APPLICATlON <br />BUILDING / EWECHANlCAL / PLUMBING ! SIGN ! SPRI <br />CITY OF EUERETT P£RMIT SERVECES <br />3206 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-2�v7-8857 j(E) everefieps@evereiiwa.gov � rw <br />(Blue or Black Ink Only Piease) PROJECT SITE INFORMATION <br />PROJECT SITE AflDRESS: 1�J3� RUCjCer AVe PROPERTYT <br />LEGAL for new construation: Short Plallsubdi�ision Lot No. (attach copy of lor <br />p.3 <br />I <br />IKLER J DEMOLITION <br />I <br />rlevererivra.gov/permi9s <br />t #_ <br />lega� description) <br />CONTACT iNFORMATION ! <br />OWNER NAME: DUail@ GI@�Ve TENANT NAME (If Gommerc{al]_ ? <br />OWNER MAILIt�G ADORESS: srcaeer 1531 Rucker Ave � <br />�� Everett STA,� WA <br />owNFR PHON�: 425-257-1164 UWNER EMAIL: <br />coNSRacTOR KAnnE Nordstrom Heating & Air Inc. <br />COt�TRACTORADDRESS: s�xeE7 4717 87th Ave NE <br />��r Ma sville <br />con�r�croR PHaN�: 425-335-4�29 c <br />CONTRACTOR LICENSE �{REQUiRED}: i10iC�SIlaSS4JW <br />sTA� WA <br />R EnnAi�: nordstrorn <br />C1TY OF EVEREIT SUSIN <br />- •.%.--: ----%i <br />� �F - [ � J � �� <br />�corn�as�.net <br />�UCENSE #lREQUIREDl:O4Z%�� <br />Pi21MARY CONTACT: ❑ OWNER 8 CONTRACTOR ❑ OTHER (P�ease Specify) <br />COtJTACT NAME: CONTACY PNONE: ,C1.25-�35-�029 ! <br />Debbie or jason coNTacr Ennai�: nordstromha omcast.r�et <br />BUILDING PERMIT APPLICATIQN � <br />Existinp Use of Building: Contract Price of Work: $ 3936 �a <br />Proposed Use of Building: Heat Source: �Gas ❑Elect �c OOther <br />Building Type: OSFR-Detached �G7SFR-Attached ❑Duplex ❑Multi-Famif -#of Units� j�Commercial �industrial <br />Type of Project: ❑New ❑Additlon ❑Remodel �Repair ❑7.1_ ❑Si n ❑Sprinkler Daem lition ❑Chan e of lJse <br />DESCRIPTiON OF WORK: <br />like in k�nd furnace replacemen � <br />ASSOGIATED BUILDING PERMIT # (if applicable): <br />PLIFMBING I <br />Type of Projed• New <br /># of Vst ofFixtures <br />Fixtures <br />Kitchen Sink & [ <br />Dishwasher <br />Clothes Washer <br />cel <br />IT APPLICATION <br />Idn Alteration Repair <br />of /�sto�Fixtu�s <br />ures <br />BackFlow Pre�enter (Inside <br />€3rinking Fountain <br />Floor Drain <br />Grease Trap <br />Roof Drains <br />Medical Gas <br />ACKNODVLEDGEMENT: I have ieviewed [his application and conrrm fhe informafion contained herefn is t�ue and correct. Work d ne pursuant to this permll must c�omply �vith <br />current federal, state, and local law. The granfin9 of a perrnit only authorrzes approved work and no deviatroas therefrom. Deviatio s must frst be outhonzed in ovriting /rom the <br />Building Officia! 6efore boing outhonzed unde� any ci�cumsfance. I am !he owner, or! am aufhorized by the owner of thu property pedorm the work for which application is made, <br />and I ca�rrply wi[h fhe State Contrachxs Law 18.27 RCW and 246.200A WAC. <br />Cihj of FvereR O�cral Use Only <br />Debbie Elgin 11-'! 4-16 I PERMIT# I�. C�—O�Z <br />Owner/Authorized Agent Signature Date (Revised 9/2 ms1 <br />