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04/06/2017 THU 12! 16 FAX FaaL Water Heater �pp2/006 <br /> qt 0 3 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLI'T'ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STFRLET,1=VERETT,WA 88201 <br /> (P)425.257-8810 I FAX 425-257-8857 1(E)eve retteps avoretiwa.gov I www.evereltwa.gov/permits <br /> Blue or Black Imk Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#; <br /> LEGAI-.for naw construetfon: Short Pfat/subdlvlslon Lot No, (attach copy of long legal daseripllon) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME if Commercial): <br /> OWNER MAILING ADDRESS: SrAr�r I <br /> �1 Cm "TATE zIP <br /> OWNER PHONE: d OWNER EMAIL: <br /> CONTRACTOR NAME; S`r <br /> GONTRACTUR ADDRESS: aTHEET S 1 <br /> cnv D 6TATF 21P ` <br /> CONTRACTOR PHONE: ' 5Com^ CONTRACTOR EMAIL: e w}} -T <br /> CONTRACTOR LICENSE#(REQUIRED): S `"), �� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: © OWNER CONTRACTOR ❑OTHER(Please Speeffy) <br /> CONTACT NAME: n 1�I _ CONTACT PHONE: <br /> U/ <br /> - CONTACT EMAIL: <br /> BUILDING PCRMIT APPLICATION <br /> Exiatlnq Use of Bulldin : <br /> `` Contract Price of Work:$ <br /> 17 <br /> Proposed Use or Building: Hent Source: C96as CElectrlc ❑Other <br /> BuIIdln Type: FR-Dolached ❑SFR-Attached ❑Du lex ❑Multl-Famfl -#of Units: ❑Commerclal ❑Industrlal <br /> @ of Pro ect: LlNew ClAdditfoD ❑Remodel gRepar ❑T.I. LISI n OS rinkler LIDetnolltlon ❑Change of Uae <br /> DESCRIPTION OF WORK: , ^ <br /> ASSOCIATED BUILDING PERMIT# If a flceble: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn z4ltaratlon _Repair Type of Project: _New __Addn __AIteratlon __Rapal <br /> #°f LtBt of Fixturas #°P Llst of F&tures °f tst cf FWures if of Llst oP F urns <br /> rlxtures �lxiuras Rxtures Fixtures <br /> AIC e Alr r Systems <br /> n Units neat Pum ilei Backflow Pr8 ntor Inolde Bldg) <br /> Forced Air S stems Unif Heater Gathtub Urina) i <br /> Gas PIpInp Boller Lavatory(Wash Basin Drinkin ' ountaln <br /> Water Heater Refrigeration Shower Flogrtralti <br /> Gae Ffre lata Wood Stove Kitchen Slnk&Disposal A Qrbaae Trap <br /> Gas Range DLICtIlIq Dishwasher Nof Dralne <br /> Clothea Dryer Hookups Other: Clothes Washer Me cal Gas <br /> Range Hood Water Heater Olhe . <br /> Exhaust Fen Slnk Service/Bar/Mo let r Other: <br /> ,SPRIN �SSIO �S'f1LM <br /> Temical or of Heade <br /> ACKNOWLEDGEMENT.'I have ravlewed this eppllcation and connnn the tnfotmadon contained Iterehi is(rue and correct Work done pursuant to this pennIf must comply w11h <br /> current federal,state,and locallaw.rhe pranUnd of a parmll only aulhorizes approved work and no devlatlons thorartom.Deviations tnusl fiml be vut'Wrtzed In writing from the <br /> Oulluing Ofliclai before being aulhor)zed under any circumstance.I®m the owner,or I am authorized by the owner of this property to perform tha work forwh/ch oppllceflon Is Mede, <br /> and 1 comply with the Slate Contractors Law f e,27 RCW and 298200A HVAC. <br /> Ci(y of Evetvit Ofliolal Use Only <br /> PrR <br /> k4m vub + <br /> Own ulhorza Ag Signature Date (RSVISBd 912V201-6) <br />