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06/19/2017 MCN 14: 59 FAX Fast Water Heater 0002/005 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-0810 1 FAX 425-257-0857 1(E)everetteps@evereltwa.gov I www.everettws,povfp0rnllta <br /> (Blue,or Black blik Only Please) n' PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: P G PPOPrRTY TAX V. DD D <br /> LEGAL for new construction' short PlauauudlviBlori Lot No. (attach copy of long legal descrlptlon) <br /> CONTACT INFORMATION <br /> OWNLR NAME: 1uLAA TENANT NAME(It Commercial): <br /> OWNER MAILING ADDRESS': srnEEr <br /> crry srnre �R <br /> OWNER PIfONL': OWNER EMAIL: <br /> CONTRACTOR NAME: fAST <br /> CONTRACTOR ADDRESS: arReer <br /> cMy STA7e ZIP <br /> qEDW <br /> CONTRACTOR PHONE- CONTRACTOR EMAII �Z Vl 1 <br /> CONTRACTOR LICENSE#(REQUIRED): S ) DN1IM <br /> j� CITY Of:EVERCTT BUSINESS LICENSEfi(REQUIMD)' <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR © OTHER(Please Specify) <br /> CONTACT NAME: I CONTACT PHONE: C <br /> t1r4 �� �/� CONTACT EMAIL: <br /> BUILDINQ PeRMIT APPLICATION <br /> I1xiathIQ Use of Bulldfn : +H..tgource; <br /> tract Prlco of Work:$ <br /> Proposed Use of Bulldin ! DOas lectrlc ❑Ottler <br /> 1BAdInGType: SFR-Dotached EISFR-Attached ❑Du lax ClMuftl-Famll -#k of Units- OCammerclal ©lnduotrial <br /> e of Pro ect: ❑Naw UAddltlon MRamode! R® afr CIT.]. OSIn 08 rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIP-fION OF WORK: / <br /> �UVI D�� l <br /> ASSOCIATED OUIL_DING PERMIT# If applicable; <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT,APPLICATION <br /> Type of Prujool: _New_ Adan _Altaratlan _RepulrrRIXI(aron <br /> Typo of Project: _New _Adds J4ltaratlon _RepRlr <br /> F/xruras LI Flxtur F( ureo List of rurros !tat ofFlxiuras Fir°B5 Llst of F/xturos <br /> P,1 —Alf Handling Unite Heat D&ip Toilet Backflow Preventar Inside Bldg <br /> 1; reed Air Systems UndHeater Sathtub Urinal <br /> ae Piping oil®r Lavato Wash Basin Drinking Fountain <br /> Ater Mea#er Refrl eratlon Shower Floor Drain <br /> 'as Flre lace AVood Stove Kitchen Slnk&Dla poeaf Grease Trap <br /> ao Range Doqtlnu Dishwasher Roo bralne <br /> C Ihes Dryer Hook u Othe Clothes Wagner . Medical Gas <br /> Ra Hood Water Heater Other: <br /> Euhaus an Sink Service/Rur/Mo p/eta Other: <br /> 1(?6$PRIN L�R�S11 ���IO M <br /> omlcal or W of Heade <br /> ACKNOWLEDGEMENT.-l havo revlewed thls applIcatton and confirm the information conialned heraln Is true end correct. Work done pursuant to this permit muet comply w/lh <br /> current federal,stele,end local low, Tho granting of a permit only aufhorizes approved won(end no devlatlons fhorelrom.Aevlatlons must flrst be authorized In wiling from the <br /> Bulfding Official before being sulliorized under any circumstance, I am the ovIner, or/em aufhortzed by Tho owner of this proparYy to perform fire wor/r(or wh(ch appltcaf(on Is made. <br /> end f comply wlfh the Stato Contractors Law 16.27 RCW and 296,200A WAG. <br /> City of Bvepett offvot use Only <br /> A UJb ( J / I PERMIT# or <br /> Own uthorTz AS A Z-4ftf 31gnaturo Date (Revtsod 9W2 2018) <br /> i <br />