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03/20/2017 MON 12: 53 FAX Fabt water Heater U002/002 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SCRVICES <br /> 3200 CEDAR STREET,EVERFTT,WA 88201 <br /> (P)425-257-BB10 I PAX 425-257-8857 1(E)everelteps(Weverettwa.gov I www.9Veraltws.gov/permits <br /> slue or slack Ink Only Pleas® PROJECT SITE INFORMATION ��1�-3a ) <br /> PROJECT SITE ADDRESS: 3 K-.F-S PROPERTY TAX#: 0V-t <br /> L.FGAI-for new construction: Short Plat/eubdlvlalon Lot No. T (attach copy of Ione legal deacrip(i❑n) <br /> CONTACT INFORMATION <br /> OWNER NAME F-s ,f CT—F e, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STnEEr Ki <br /> My aTATL ZIP <br /> OWNER PHONE: OWNER EMAIL: ` <br /> CONTRACTOR NAME: I� ST M--- T <br /> CONTRACTOR ADDRESS: STREer 1,J <br /> CITY 57nTe zlk <br /> CONTRACTOR PHONE, L0 CONTRACTOR EMAIL:ff V,01 1T S �V AW, a <br /> CONTRACTOR LICENSE#(REQUIRED); �j� A.CITY OF EVERE`rT BUSINESS LICENSE#(RE(ZUIRFC): <br /> PRIMARY CONTACT: ❑OWNER §CCONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: r CONTACT PHONE: <br /> CONTACT EMAIL: �yI/11tS <br /> BUILDING PERMIT APPLICATION <br /> ExIstIng Use of Bulldin : Contract Price of Work:$ <br /> Proposed Use of Bulldin H®at Source: 006as QEIeCtHc 1710ther <br /> Building Type: FR-Detaohed ❑SFR-Attached MDu lex IlMultf-Famll -#of Units: LICommerclal 171ndustrlal <br /> T`yp&pfP!�o)!ecl, ❑Now ©Addition UkornQdel R® air C1T.L MSi n ©Sprinkler ❑Demolition LIChan e of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# If applicable): <br /> MECHANICAL PERMIT APPLICATION Pi.UM139NO PERMIT APPLICATION <br /> Type of ProlaoC _Now Addn __A terottun _Repair f� Type of Project: __Now �,Addn �Iteratlon ,_Repelr <br /> Fixtures Lls!of Fixtures Flxtu List of Fixtures Flxt%s Lis e of F u Fixtures A of List of FI es <br /> A10—Air Handling Units Haat Pump Tallet Backflow Pre a ter 1psids Bldg <br /> Forced Air Systems Unit Floater Hathf ib Urinal <br /> Gas Piping Boller Lavatory Wash Basin DrIpki6g Fountain <br /> Water Heater Refrigeration Shower Kbor Drain j <br /> Gas Fireplace Wood Stove Kitchen Sink&Dla oval ease Trap <br /> Dae Ran s Ducting Dishwasher RN Drains <br /> Clothes D er Hookups Olher: Clothes Washer . Medl i Gas <br /> Range Hood Water Heater Other <br /> Exhaust Fan Sink Servic r/Mo etc. other: <br /> $PAIN !~SS[O 1111 i <br /> emloal or W of Heads <br /> ACKNOWLEDGEMENT 1 have Mvlewed lhls eppiloarlon and confirm the Inrormallon conlalned herein Is true and correcl.Work done pursunnf b this permit must comply with <br /> current fadaral,stele,and local law.The granting of a permit only outhorfres approved work and no devlghona therefrom-DavlaUons must first be authorized In wMing ham the <br /> Bullding Orticlal Salo»beteg authortred under any circumstance,tem the ownar,orl&m suthodzed by the owner or(his property to perform the work for which epplicetion Is made, <br /> errd l comply with the S1eta Contraotors Law 19.27 RCW end 386.2aos{WAO <br /> City of Everett Oftfal use only <br /> �4 1 A LCUb <br /> PEM <br /> OWMVAuthorTze-d Agbrrt Signature Date (RevisedW23R010 <br />