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05/01/2018 TUE 7: 02 FAX 425 415 6867 Fast water Heater z003/005 <br /> Sil i.-0-10(11 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN I SPRINKLER/DENIOLITION <br /> . r�� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 88209 <br /> (P)426.257-8810 J FAX 426-257-8857 I(E)everetteperaeverettwa.gov I www.everetlwa.gev/permits <br /> (ElSlack ink Only Please) PROJECT SITE INFORMATION <br /> ;PROJaaeEC o!SITE ADDRESS: 1 5. NJ 5 RDADivAll ,PROPERTY TAX#: app&I) , V <br /> LEGAL for new construction: Short Prat/subdivision of No, (attach copy of long legal description) <br /> CONTACT INFORMATION-. - <br /> OWNER NAME: CO ) - .1'A A 'TENANT NAME(If Commercial): A .4111 Ai il1dit.,1 <br /> OWNER MAILING ADDRESS: ;mar ar <br /> Lar ft. i, 404 _et � �Milll <br /> • <br /> CnY ' 1 ' STATE , IJP , ♦ 00 0 <br /> OWNER PHONE: e' 3b 1 OWNER EMAIL: -'-- , <br /> CONTRACTOR NAME: f,P(ST iniAi --4 AkT�r�g, ]_�. _ ---- -- <br /> _____ <br /> CONTRACTOR ADDRESS; WREST y�\'(1��("i.`5�i �j I 'X��Qj ' S it C 1 )(P 1 <br /> -- - I ,-- o`rY '1(J V 11 I VI-V eA� i i. YIP P e ! L <br /> CONTRACTOR PHONE: —l�S ' 1j CONTRACTOR EMAIL:P P.,iM ITS As.\-wo P,r I O . (A ].i <br /> CONTRACTOR LiCENSE#(REQUIRED): SIM/00' 3 BL CITY OF EVERETT BUSINESS l_1QENSP#(REQUiRED) Lf 3 <br /> PRIMARY CONTACT: ID OWNER (CONTRACTOR ❑OTHER(Please Specify) ^ <br /> CONTACT NAME: CONTACT PHONE: LI , ' ,,,. �p e <br /> ICAl- \ V--W,. - CONTACT EMAIL: lM11- ' ;S-1 �J,A 'll.Pa'O! . CA)Al <br /> BUILDING PERMIT APPLICATION <br /> 14Existin• Use of Bulldin•: ,�A 11 . " Contract Price of Work:$ _ <br /> N Proposed Use of Building: I WW1 , Heat Source: ©Gas ©Electric Dotter - <br /> Building Type: OSFR-Detached ❑SFR-Attached ©Duplex CDMuftl-Family-#of Units:____ ,[Commercial ©industrial <br /> Type of Project IDNew ❑Addltlor+ CiRemodel (Repair CIT.!. C ISign EISprinkler ODemolitlon CIChange of Use <br /> DESCRIPTION OF WORK; <br /> f VYI 0Ue., l re1;1\j.Ce C S LA)Ock-eir C 0A; <br /> ASSOCIATED BUILDING PERMIT# If a••licable: I `'/i C 1a4 <br /> -MECHANIiCAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Protect: ,__New_ Addn _Alteration _Repair Type of Project: _„New , lddn _Alteration Repair <br /> Fixtes u List of Fixtures Furs (.J of Fixture? Fl u List of Fixtures res Fixtures •f R&M? <br /> NC-Air Hendilo Units `Heat Pump Toilet Backflow Piave ter-Inside Bid. <br /> Forced Air Systems Unit Heater Bathtub Urinal _ <br /> DGas Piping Boiler _ Leveto (Wash Basin) Drinking Fo ,,..In <br /> Watsr Heater- Refrigeration Shower Floor Dr- _ <br /> Gas Fireplace Wood Stove Kitchen .k&Disposal G =-:=Trap <br /> Gas Range Ducting Dishwasher •of Drains <br /> Clothes Dyer Hookups Other: Clothes Washer Medical Gas - - <br /> Range Hood Water Heater --- Other: ______ <br /> Exhaust Fan _ Sink Service/z• o.etc. •titer: <br /> SP IN me. r c>r rasa SSIO <br /> I� ��---- �cr lR [��1FSTI�M <br /> Iiemlcal or W r— �, Heads . <br /> ACKIVOWLZDGEAMAIr I have reviewed this application and confirm me information contained herein to true and comsat.Work done pursuant to this permit must comply with <br /> current federal,slate,end local law.The granting ore permit only authorizes approved work and no deviations thereicarn,Oct/Alfons must Pkat be autfarIz d In Writing from the <br /> Building Official before being authorized under any cfraumatanca 1 em the owner;;or!am authorized by the owner of this properly to perform Ms wort for which application is made. <br /> and/compel with the State Contractors Caw/a27 ROW and 29a200A WAC <br /> City or&bereft Officio/Ws Only <br /> • <br /> "A_ , A .....z,_.,_. 5.-1 - i a 0- dui• 3 <br /> Own' •uthor ze;Ag Signature Date. (Ray se. • 3/201i <br />