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04/06/2017 THU 12: 17 FAX Fant water Heater [;L0 0a/006 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CI'rY OF CVC-RFTT PERMIT SERVICES <br /> 'STT 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)426-257-8810 I FAX 425-257-8837 �(G)everattepsUevora(Iwo.gov I w%vw.everetlwa.gov/permlts <br /> Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: W U K �f PROPERTY TAX#: <br /> LEGAL for new conairuo(lon: SIioR Plot/subdivlslonLot No__ (attach copy of long lagal dascrfpllon) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAMEIf Cornmerclal): <br /> OWNER MAILING ADDRESS: S,Res r <br /> 1 Crry 9YATE ZIP <br /> OWNER PHONE: v, r© OWNER EMAIL: <br /> CONTRACTOR NAM> ; ST T <br /> CONTRACTOR ADDRESS: sTREST S <br /> CrTr STATE! ZIP 1 <br /> CONTRACTOR PHONE: `l�sCn^ CONTRACTOR EMAIL: <br /> CONTRACTOR t !CENSE#(REQUIRED): Sr 0�, t✓ CITY OF EVERETT BUSINESS LICENSE#(REQUISZED): <br /> PRIMARY CONTACT: CI OWNRR §tCONTRACTOR ©OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> �IE-- CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Exi,stfnq Uae of Bulldin : Contract Price of Work:$ <br /> Pro osed Use of Budding; Heat Source: IJGns lectrlc ❑other <br /> 113ulldingT e; FR-Detached OSFR-Attached ❑Du lex ©Multi-Famil -ff of Units: CICommerelal I71Indusirlal <br /> Type of Pro oct: I-JNew []Addition ❑Remodel &epair ❑T.I. 051 n 05 rinkler C7Domolldon ClChan e of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED I3U(LDING PERMIT# If a Ilceble <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Proj0Ctl aw Addn __,Alteration _ pair Type of Project: _New _­Addn _1Altaratlon _Repair <br /> 3 of List of Fixtur #°f o't-f Fixtures °f l ivt of F/xturea of List of Hxturos <br /> Fixture Fixtures Ffxturea Fixtures <br /> A/C—Air Handlln Un s Heat Pump at backflow Preventer Inslda 13 <br /> Forcod Al S stems Unit Heater Bathtub Urtnel <br /> Gas PIpiny 13011er Lavatory(Wash Basln Ddnk[nQ Fountain <br /> Water Heater Refrl erBiion Shower Floor Draln <br /> One Flre lace Wood Stovo Kltehen Slnk&Erle oeol Grease TTa <br /> Gee Ran2e DUCtIng IDishw@rher Roof Dralne <br /> Clolhes er Hookups Other: Clothes Washer Msdlcai Gas <br /> g—Hood Water Heater Other. <br /> 1777chaust Fan Slnk Service/Bar/Mo /etc. Other: <br /> SPRiYJSL M <br /> a9mlcal or W of Heade <br /> ACKNOWLEDGEMENT:1 have reviewed this appilcatlon and confGm the Information conta/ned/Wein Is true and correct, Work done pumuont to IN,?permit must comply with <br /> current/adoral,state,end local law,The grenf/ny of a permit only aulhorizes approved work and no deviations thorefrom.Deviations must//rsf be authorized In writing from the <br /> Vulldblp Oft/of botory being authodzad under any circumstance.I am fhe owner,or Ion)aurhwtzed by the owner or tbra properly to perform the work for which appilcetion la mada, <br /> and t comply with the State Contractors Law 16.2Y RCW and 286.200A WAC_ <br /> City of Everott Off/cAl Use Only <br /> v i PERMIT# <br /> OwnHau(horTzA Ag6nt Slgnaature, Date l (ROvise 9 2 20 6) <br /> I <br /> I <br />