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04/12/2017 WED 15: 04 FAX Fabt water Heater �OV2/003 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CIT`{OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98209 <br /> (P)425-257-6890 1 FAX 425-257-8857 I(E)everettops@evereltwn,gov I www,everelEwa,0ov/permlW <br /> Blue or Black Ink Only Please) PROJECT,SITE INFORMATION <br /> PROJEGT SITE ADDRESS: t- PROPERTY TAX#_ <br /> LEGAL for new construction: Short PInUautidivlslon Lot No_ _ (attach copy of long legal deRcription) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Gommercllal): <br /> OWNER MAILING ADDRF_SS; eTREST b L <br /> CI1Y / STATE L� <br /> OWNER PHONE: OWNER EMAIL; <br /> CONTRACTOR NAME: f ST j T <br /> CONTRACTOR ADDRESS: STREET , S <br /> CrrY V eTATF ZIP ` <br /> CONTRACTOR PHONE: 5 ` CONTRACTOR EMAIL: i�F-Uri <br /> CONTRACTOR UCENSK#(REQUIRED);F 5"rW � gj� CITY OF EVERETT BUSINESS L)CENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑o,rh(ER(PI®ase Speclfy) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: e/ i'ts <br /> BUILDING PERMIT APPLICAXION <br /> ExiatIng Use of BUIldin : Contract Price of Work;$ <br /> Pto o9ed Use of Bulldfn Heat Source: ❑Qas Electric ❑Other <br /> ISLI11dingType: ❑SFIR-Delaohed C7SFR-Attached ❑Du lex Multl-Famll -#o(Untts: ©Commercial ❑Induetrlal <br /> T e of Pro ect; ❑New ElAddltlon ❑Romodel XRepolr CIT.L 0,91 n ❑S rinkler ❑Demolltlon ❑Chen e of Use <br /> DESCRIPTION or WORK: <br /> 4SSOCIATUD BUILUING PERMIT# if a2211cable : <br /> Il eCHANICAL PERMIT APPLICATION PLUMBING PgRM1Y APPLICATION <br /> Type of Profccl: -New Addn Typa of Projact: _Naw _Addn �ltorallon _Repair <br /> FLrlures <br /> List o/Fixtures Fixtures List o lxtures Pixturos List ofFtxtures Fixtures List ofF/xturou <br /> AfC—Air H—aftdlUnits H Pum Tollet SackflDW Praventer inelde 91d <br /> Forced Air Sys tonit Heatar Rathhlb Urinal <br /> Gas Piping­_ Boller Lavatory Wash Basln DrInkIng Fountain <br /> Wafer Heateri Refrl eratlon Shower Floor Drain <br /> Gas Fire lno Wood Stove Kitchen Sink&Dls Dsal Grease Trap <br /> Gas Ran B Ducting LAshwasher Roof Oralns <br /> Cloihes Dryer Hoo e other: Clothes Washer Medical Gas <br /> Ren a Hood Water Heater Other. <br /> Exhaust F2LSink Service/Bar/Mo /elo, Other: <br /> $Pal lg8S10 y-STRM � <br /> emlcel or VV o.of Hclads <br /> ACKNO WLEOGEMI:NT.f have reviewed fhls applicallon and eonflrm the lnfofnwilon contalned herekr/s free find correct,Work done pursuant to this permit must comply w/th <br /> curmnl federal,slate,end locellaw, The granting of a permlt only authorizes approved work and no davtationo Nrorefrom.Doviatfons must r1rst be allthorizecl In writing from the <br /> Bultdina Official bolos boing authorfzed under any chcumsfanca.f am fho owner,ort om authorized by the owner of this propaffy to perform the work forwhfch app/Icaflon fs made, <br /> and/comply with the Slats Contractors LOB'1827 RCW and 298.200A WAG <br /> City of Everett OfflCfaf Use Only <br /> PERMIT <br /> A bVl/ I �'] ] -j <br /> Own uthorze Ag f'9lgnature D9ta Rev/38 912,112U7 ) <br /> i <br />