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04/25/2017 TUE 10: 34 FAX Fant water Heater 2007/008 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL 1 PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 88201 <br /> (P)425-267-8810 1 FAX 423-2578837 1(E)everettep eavaretlwa.gov I www.everettws.gov/permits <br /> Blue or Black Ink Only Please) PROJECT SITE INFORMATION y� <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: D 3.5557 O <br /> LCGAL for now constrvotlon; Short Plot/subdIvlsion Lot No, (attach copy of long legal deacrlptlon) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME If Commercial): -- <br /> OWNER MAILING ApDRESS: sTRaeT <br /> CITY STATE ZIP _I <br /> OWNER PHONE: P2 -3, 00 OWNER EMAIL: <br /> CONTRACTOR NAM H: S T <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STAT@ ZIP <br /> CONTRACTOR PHONE: `'�S CONTRACTOR EMAIL: R V}') a!� PikWayIvI b <br /> CONTRACTOR LICENSE V(REQUIRED) Sr t✓ CITY OF EVERETT SUSINEBB LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 1:1 OWNER (CONTRACTOR O OTHER(Please Speolfy) _ <br /> CONTACT NAME; K n �[ I ACT PHONE:1` �/ CONTCONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing We of Building: Contract Price of Work.� <br /> Pro osed Use of Building; Heat Sourca, r7Gas Electric ©Other <br /> 160dIng ae: FR-Detached 0SFR-Attached ©Du fox OMLIM-Family-#of Units' ❑Commerclai 131ndustrlal <br /> T e of Pro ect; CINew OAdditlon MRerrlodel Re air OT.I• OSI n OS rinkler IADemolitlon I]Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PhRMIT if If applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Projact; New Addn _Alteration efikepair Type of Project: _New J/lddn ,-Alteration __jtepalr <br /> 4 of uat of Fixtures #ofLlat of Fixtures #of U'7t of Fixtures #of Llst of Fixtures <br /> Fixtures F/xtur Fixtures Fixtures <br /> MC,Alr H2Ang Units Heat Pump Tollet B9ckfiow Preventer inside Bldg) <br /> Forced Air S ste Unit Heater bathtub Urinal <br /> Gas Plping Boiler Lavatory Wash Basln Lmnldnq Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> bas Flre face I Wood Stove I Kitchen Sink&Disposal I Grease Trap <br /> Gas Ran a Duotin Dishwasher Roof Draine <br /> Pathos <br /> or <br /> Hookups Other: Clothes Washer . Medical Gas <br /> Hood Water Heater Other: <br /> t Fan Slnk Service/Bar/Mo /0tc. Other: <br /> SARIN �SRIO M <br /> i <br /> ®mlcaf or W tom.of Heade <br /> ACKNOWLI=DGEMENr f have rovlewed fhre appllcaflcn end confirm the/nfwwallon contained hereh)is trua and correct Work done pumuent fo this permit must comply wllh <br /> current foderal,state,and tooat taw.The granting of a perm/l only aulhorizas approved work and no dovlations thorefrom.Deviations must jird be authorizer)In wrlting from the <br /> euliding Offlolal before being autho/lzed under any circumstance.l rim the owner or/am authorized by the owner of this property to perform the work for which appllaation!s made, <br /> and l comply with the State Contractors 4aw t a.ZY ROW and 2i)0.200A WAC. <br /> City of Everett OIJlclal Use Only <br /> A i <br /> /O <br /> own uthor ze Ag Signature Dale R® sed 9,12V71-6f <br />