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04/06/2017 THU 12: 17 FAX Fast water Heater f( VV3/VV6 <br /> PERMIT APPLICATION <br /> BUILDING/M>=CHIANICAL/PLUMBING I SIGN/SPRINKLER / DEMOLITION <br /> 4M7TCITY Or EVERETT PERMIT SERVICES <br /> 3200 CEDAR 5TRE kCr,EVERETT,WA 0201 <br /> (P)425-267-8610 1 FAX 425.287-8857 1(E)everelteps@evereltwa.gov I wvvw_everettwa.gov/pormlts <br /> Blue or Black Ink Only Please} PROJECT,SITE INFORMATION VQ co <br /> PROJECT SITE ADDRESS I- PROPERTY TAX 4: <br /> LEGAL for naw construction: Short Platinubdivlslon Lot No. _ (Attach copy of Ione legal deecrlptlan) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commerclal); <br /> OWNER MAILING ADDRESS: aTResr S f <br /> MY STATE 21P (J <br /> OWNER PHONE, OWNER EMAIL: <br /> CONTRACTOR NAME; S T <br /> CONTRACTOR ADDRESS: STREET I S <br /> crTY sTnTe zm ` <br /> CONTRACTOR PHONE: _l s C CONTRAC-roR r:MAII-: <br /> CONTRACTOR LICENSE#1(RI=QUIRED)!fPv r } 1 I CITY 01=EVERETT BUSINESS LICENSE#i(RE4UIRED): <br /> PRIMARY CONTACT: L OWNER (CONTRACTOR ❑OTHER(Please Specffy) <br /> CONTACT NAME; CONTACT PHONE: L <br /> CONTACT EMAIL: I —S C 4e, , , CIO <br /> BUILDING PERMIT APPLICATION <br /> Exiating Uue of Building. Contract Price of Work:$ <br /> WD <br /> Proposed Use of Sulldlng lHeat,90UMO: as EJ✓"lertrk: ❑Other ' <br /> Bulldin Type: PR-Datach9d ❑SFR-Attached ❑Du lex 0Mu1ti-Fam"11 -#of Unita: ❑GommerClel L7Industrial <br /> Typo of Pro ect: QNew ClAddltlon LARemodel Re air ©T.1. ❑Si n ©S rinkler ❑Demolltlon ❑Chan a of Use <br /> DESCRIPTION of WORK: <br /> ASSOCIATED 13U1LpING PERMIT# If a Ilcable <br /> WCHANICAL PERMIT APPLICATION fPL-UMBINO PERMIT APPLICATION <br /> Type of Project: New Addn _ A[taratlon _Repair Typo of Project: _Now ^Addn _Alteration _Repatr <br /> Flxtur' Hat of Flxtures Fj fe3 Lts t of Flxturos of Ltst of FT s 0 of List of Fl raa <br /> Fixtures Fixtures <br /> A/C--Alr Handling Units —IjwtPume Taflat Backflow Prove r Inslda Bldg <br /> Forced Alr 5 st®ms Unit Heater bathtub Urinal <br /> Gas PIPInq Boiler Lavato Wash Basin DrInkIng Fxrbntaln <br /> water Hooter Reftl 6ratlOn ShowerFloor 'In <br /> Gas fire lace VVaod Stove Kitchen Slnk&1713osal N OfAdso Trap <br /> Gae Rene DuctIng DIshwashar o Drains <br /> Clothee Dryer Hookups Other: Clothes Washer . Me al Gas <br /> Ran Mood Water Heater Other: <br /> Exhaust Fan Slnk Service/Ear/Mo ® Other, <br /> SI'1tIN I S810 M l <br /> emlcel ar W of Heade <br /> ACKNO WLFDGEMf=N7i f have reviewed this appitca0on and confirm the lnformallon contained herein Is true,end correct.Work done purauent to this pant(must comply with <br /> current federal,stere,and local low. The granting of a permit only autllodzes approved work and no devlullons thoreftom.Devlafluns must llrst be authorizad In writmq Dom the <br /> Building OfficAl before being aufhodzed under any crrcurnsfenca.I em the owner,or i am authorized by the owner of Ih/s ppper(y to perform Ilia worlr forwh/ch application Is made, <br /> and I comply w/lh the Sta(e Contractors Low 19.27 RC W and 296.280A WAC. <br /> City of Everett Offlelal Use Only <br /> PERMIT tl.it I i 9 <br /> --,, <br /> - - Li- I -h I <br /> OwnhfTAuthoiiTze'd Ag4M Stunaturo Date (Rev/6edV12312015) <br /> I <br />