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To: Page 2 of 2 2016-09-19 20:51:48 (GMT) 18884000383 Froin: Deborah Shields <br /> PERMtT APPLlCATION <br /> BWLDING / MECHANICAL / PLUMBING / SIGN / SPRtNKLER/ DEMOLITtON <br /> GTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov J www.everettwa.govl�ermits <br /> (81ue or Black Ink Oniy Rlease) P:ttOJECT SI'I`� IN�ORMATIOrN '' <br /> PROJECT SITE ADDRESS: 2126 RUCKER AVE PROPERFY TAX#: 00433-143201900 <br /> LEGAI for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal descripticn) <br /> GONTACT INFORMATION <br /> OWNER NAME: DIANA LYNN TENANT NANiE(tf Commercial): <br /> OWNER MAILING ADDRESS: srReEr 2126 RUCKER AVE <br /> CI"IY Everett STATE VV� ZIP 98201 <br /> owN�� Pt�oN�: 425-941-8087 OWNER EMAIL: <br /> CONTRACTOR NAME: Washin ton Ener Service <br /> CONTRACTOR ADDRESS: srHeer 3909 196th St SW <br /> c�TY Lynnwood sTnre WA ziP 98036 <br /> coNTRACTOR PHON�: 360-945-2787 coN��,croR Etwa��: dyanna@nwpeimit.c - �=_-----���� <br /> CONTRACTOR L(CENSE#(REqUIRED): 1/�/ASHIES$51 NS ClTY QF EVERETT BUSfNESS LICENSE#(R UtREDj: 054773 <br /> _._ __. __. ..... . .. <br /> PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑OTHER (Please Specify) <br /> corvTacT►�ann�: Dyanna Sconzo cor�zacT nHontE: 360-945-2787 <br /> CONTACT EIVtAIL: d anna�nw 't.com <br /> : BUILDING:P.ERI�IT ARi'LlGATION '- ' � <br /> Existing Use of Building: Contract Peice of W �k�:$ 1,941.25 ° <br /> Proposed Use of Building: Heat Source: ❑ s ❑Electj�c' ❑Other <br /> Building Type: �SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Family-# of Uniis: � ❑Commercial ❑Industrial <br /> T e of Pro"ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolifion ❑Chan e of Use <br /> DESCRIPTI�N OF WORK: <br /> Replace Electric Tankless Water Heater <br /> ASSOCIATE� Bt1iLDiNG PERMIT# if a licable: <br /> MECHANICA� PERMIT ARPLICATION '. ` ' `' PLUMBING P�RMIT APPL1GATiON : <br /> Type of Project: _New ^ Addn _Alteration Repair Type of Project: _New _Addn _Alteration X Repair <br /> Fixtures List of Fixtures FI tures Lisi of Fixtuies #oi Lisi of Fixtures #of tist ot Fixtures <br /> Fixtures Flxtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavafory (Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kifchen Sink & Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Fiookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink Service/BarlMo letc. dther: <br /> ; SPRINKLEM2/`SUPPRES:iION SY3�'EM : ` '" <br /> _. <br /> Number of Heads <br /> ACKNObVLEOGE�v1ENT:!have reviewed this applrcafion and confirm the Information contained herein is true and con�ct. Work dona pursuant to ihis per'rnit musf cumply wifl� <br /> current tederal,state,and local law. The granting ot a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in w�lfing from the <br /> Building Official batore being autliorized under any ciraamsfance.I am fhe owner,or I am authorized by the owner of fhis properfy fo pertorm ihe wo�k fior which application is rnade. <br /> and l comply with fhe State Contractors Law 18.27 RCW and 296.200A WAG. <br /> Cify of Everett Oifrcia!Use Only <br /> f'1"a f,�n a S�0 nZ� Dic�itally slgned by Dyanna Sconzo PER IT <br /> LJ y Date:2016.Q9.19 13:48:10-07`00' oa ,^, O <br /> OwnerlAuthorized Agent Signature Date (Revised 5i20/2016) <br />