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04/12/2017 WED 15: 04 FAX Fast water Heater [ 003/003 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/ SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8657 1(E)everelleps®evereltwa•gov I wnvw.ever0tlwa.gOv/psrmlts <br /> glue or Slack Ink Only Pleas® PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 91) I— V PROPERTY TAX#: <br /> LEGAL for now oonatructivn: ShortPlaVsubdlvlalon Lot No. (alrnch copy of lono legai deocripllon) <br /> CONTACT INFORMATION <br /> OWNER NAME: i a I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT <br /> any sr / ZIP <br /> GVVNLR PHONE: C?n� OWNER EMAIL: <br /> CONTRACTOR NAME: ST <br /> CONTRACTOR ADDRESS: s7REEr S <br /> l , CITY D r1TAT-E ZIP L <br /> CONTRACTOR PHONE: ') C 1 CONTRACTOR EMAIL: "-Q,M �T S 4e/-, � <br /> CONTRACTOR LICENSE#(REQUIRED):f 5T w �"I CITY OF EVERETT BUSINESS LICENSE V(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 56ONTRACTOR L7 OTHrzR(Pioase Spsctfy) _ <br /> CONTACT NAME: CONTACT PHONE: 1 <br /> CONTACT EMAIL: -. vvt V- s (k) -�W. If-" <br /> BUILDING PERMIT APPLICATION <br /> ExMIng Use of Building: Contract price of Work:.$ <br /> Pro osed Use of Buildin : Heat Source: roGas ❑Electric DOtner <br /> Bulldln Type: OSFR-Detached ❑SPR-Attached ❑DU lex ultl-Famll -#of Units: ❑Commarclal ❑Industrial <br /> Type of Pro ect: ❑New ❑Addition L7Rertlodel Re air LIT.I. MSI n MS rinkler MDsmoutton ©change of Use <br /> DESCRIPTION OF WORK: <br /> C -- <br /> w lea <br /> /ASSOCIATED BUILDING PERMIT# If A Ilcable: <br /> MECHANICAL PERMIT APPLICATION PLUMBINGI PERMIT APPLICATION <br /> Type of Projact: _New _ Addn �ttaratlon _Repair Typo of Project: _Now �ddn �_.Altaratlan _Repair <br /> Flxturas fist of Flxturea FG#tures Llst of Flxturos t lxturas6("Flxturas F ��s Llat of Fr res <br /> A/C-Air HandlingUnits Meat Pum ackflow Prev er Inside BId <br /> Forced Ar 5 stems Unit Heater ai <br /> Gae PI In Boiler sh Basin Drin In ountaln <br /> Water Heater Refrl eratlott Flo rain <br /> Gas Fireplace Wood Stove tcennlc&Disposal OeiaeTrap <br /> Gae Ran s Duoting olshwaehor I Roof DI 4119 <br /> Clothes Dryer Hoaku a Olher: 21othes Washer . Medical OVs <br /> Ran a Hood VVater Heater Other: <br /> Exhaust FanSI ServicelBadMo c. Other: <br /> SP�iIN QSS10 1VI i <br /> emlcal or W Za of Heads <br /> ACKNOWLI:pGFWAIT'l have mvlewed this applleallon and confirm the lnfomrallon conlalned hereln Is free and correct Work done purduant to this pormlt must comply w/llr <br /> current federal,state,and local law.The granting oto perma only authorizos approved Work and no deviations thorefront.Devlatlons must flair be aulltorized/n waking from tho <br /> Pulld/ng Olftclal balbro be/ng authorized under any clrcumslance,I am the owner, or I em authorized by the owner of(his property to parform the work tot-which sppl/callon Is meds, <br /> and I oomply wllh the St&te Contracbrn Law 16.27 RCW and 298.200A WAG, <br /> city of Everett OIl/clal Uso Only <br /> 'I <br /> — f `� — ( � PERMIT# <br /> JA UJL 1 l ` 1 <br /> Ownuthorza Ag Signature Date (t7ovlsed912312016) <br />