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04/25/2017 TUE 1.0: 94 FAX Fant water Heater — j006/003 <br /> PERMIT APPLICATION <br /> q09 3C <br /> BUILDING /MECHANICAL/PLUMBING / SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVEM=--n-PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98209 <br /> (P)425-257-6810 1 FAX 425-257-8857 1(6)everetteps@evarellwa,®ov I www.everottwa,gov/pormlts <br /> iBlue or Elack Ink Only ♦Pleas® PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: IJ-6 a PROPERTY TAX <br /> LEGAL for now conatruvtlon: Short PlsUaubdivielon __.______Lot No.,__.._ (altach copy of Ione legal description) <br /> CONTACT INFORMATION <br /> OWNER NAIVIE: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTra6ar 'I D I A I CAS <br /> CnY STATE 2tP <br /> Ll <br /> OWNER PHONE: IU W11 I I OWNER EMAIL: <br /> CONTRACTOR NAME: fA ST T <br /> CONTRACTOR ADDRESS: s7prrr WS ' <br /> CITY D STAT@ ZIP <br /> CONTRACTOR PHONE: 1� CONTRACTOR EMAIL: l��VYl1TS <br /> CONTRACTOR LICENSE#(REQUIRED): 5rjti s I CITY 0I:EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: ©OWNER CONTRACTOR ❑OTFIER(Please Specify) <br /> CONTACT NAME: \ CONTACT PHONE: 1-4 <br /> CONTACT EMAIL: 0A'I-tS <br /> BUILDING PEfRM1T APPLICATION <br /> Existing Use of Buildin : Contract Price of Work:$ <br /> Pry osed Uae of Building: Heat Source: ASS ❑Electric C70f1]er <br /> 1RuIId[n,gfype'AFR-Detached USM-Attached ❑Du lex ❑Mull)-Famll -#of Units: QCommeralel ❑Industrial <br /> T)fpaof Project: ONew MAddition 01'Remodel Xll ❑T,i. ❑Sin OS rinkler ODemolltion 00han a of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT fA If a llcabie: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PirrRMIT APPLICATION <br /> Type of Project. ___New_ Addn _/ltteretlan _Repair Typo of Project: New ,_Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixturos #Of <br /> Li of FIX, <br /> #o! List of Filet s <br /> Fixtures Fixture,a Fixtures res <br /> A/C—Alr HandlIng Unito Heat Pump TollaV Backflow Preva r Inglde Bid <br /> VI <br /> Forced Air Systems Unit Hnater Bat ub Urinel <br /> One p1ping Boiler Lav to Wash Basin akin untaln <br /> Water Heater I Reffi eratlon Sh war Flo rain <br /> Gas Fireplace Wood Stove Kit hen Sink&Die osal grgasxTrap <br /> Gaa Ran ® DuctingDI washer Roof DrNs <br /> Clothes Dryer Hooku a Other: Cla es Washer . Medical Ga <br /> Ran a Hood Wa Heater Other: <br /> Exhaust Fan Sink rvlce/Dar/Ma Other. <br /> jql��PFtIN !� 1;58[0 �-$T]?ItII I <br /> ernlcai or W R.of Heads <br /> ACKNOWLFAGEMENT:i have reviewed this application and contlrm the Information Contained herala is true noon cormci,Work dare pursuant(o(his permit must comply with <br /> current federal,aisle,end local law_The granting of a permit only authorizes approved work and no devlarlons tharefrorn.Deviations must Rrst be aulhor&ed/n writing from the <br /> Building OUlclal before baing vulborizad under any olrcumsience,I em the owner,or I am euthodzed by the owner of thls property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Low 10,27 RCW and 2Bd2aaA WAC <br /> City of Everett Official Use Only <br /> A UJbq . 05, ! 1 <br /> PERMITIM <br /> I�p�I t <br /> L? I <br /> Own uthor ze Ag Signature Date (Revised 9/2 26 a U-1 <br /> I <br /> 1 <br />