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04/28/2017 FRI 9: 05 FAX Fa6t water Heater 0002/004 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL I PLUMBING 1 SIGN /SPRINKLER/ DE=MOLITION <br /> CITY OF EVERt°'rT PERMIT SERVICES <br /> 3200 CEDAR sTRLET,EVERETT,WA 98201 <br /> (P)426-257-8810 ! FAX 425-2578857 1(E)evereltepa@everattwa.gov I www_everettwa.gov/permlta <br /> Blue or Black Ink Onl Please) PROJECT SITE INFORMATION <br /> PROJI_GT SITE ADDRESS. !/ PROPERTY TAX#: <br /> LEGAL for new constru°Ilon: ShortPlat/subcllvlslon Lot No. (attach copy of long legal dascrlptlon) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME If Commerclal): T <br /> OWNER MAILING AOI)RI;SS: STFtCF;T <br /> crrrsrAYE ZIP ` <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; S T <br /> CONTRACTOR ADDRESS: BTRELT I S <br /> c TY STATE ZIP 1 <br /> CONTRACTOR PHONE: (-�a s C CONTRACTOR EMAIL;E <br /> g U?1 ITS LU D <br /> CONTRACTOR LICENSE#(REQuIREp);� Sr�/�} CITY OF EVERETT BUSINEs3 LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER 5tCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: /� CONTACT PHONE: <br /> K/'r� CONTACT EMAIL: L�� ( w <br /> BUILDING PERMIT APPLICATION <br /> Existlnu Use of aulldin Contract Price of Work:$ 157 1'6 <br /> Proposed Use of RuIldIng, LyElectric ❑Other <br /> Buildln e: FIS-Detached SFR--Attached ODu lex OMultl-F2mll -#of Units; ❑Commercial ©Industrial <br /> T e of Pro ect: ONew ❑Addition C1Remodel Re air ❑T,h ❑Sin ❑S rinkler C7C78moIlClon ❑Change of Use <br /> DESCRIPTION Or WORK: <br /> ASSOCIATED BUILDING PERMIT ff If a llceble: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Projoct; Now Adtln __..._AItaratlon _Repair Type or Project: _New .__,Addn _ Alteration _Ropalr <br /> of kfat oPFW Flxf°�uras List o -turFixtures es °f Ilsr of rWurea #of Llst of flxluros <br /> Flxtur Ffxturas <br /> FVC,Alr Handling Unl 99,Kpurnp Tollat Backflow Preventer InSlde B d <br /> Forced Alr Sstems nlf Heater Bathtub Urinal i <br /> Gas Pl n Boller Lavatory Wash Basin DrInt(Ing Fountain <br /> Water Heater N, Refrl eratio)n Shower Floor Drain <br /> Gas Flre lace ood Stove Kitchen Sink&Dle oeel Grease Trap <br /> Gas Range DXtlng Dishwasher Roof Dralne <br /> Clothes Dryer u e OthoN, Clothes Waaher Medical Gas <br /> Range Ho Water Heater Other: <br /> Fen $Ink Service/Elar/Mc /etc, Other: <br /> 3P�21N M <br /> emlcal or W of Heade <br /> ACKNOWLEDGEMI=NT`1 have rovlowed this epplteaUon and confirm the laformadon conlalned Aerefrt is true end correct.Work Jona pur.7uenNo lh/s parmltmust comply w1th <br /> cunenf federal,stale,and local law.Tno grantlnp of a permlt only aufhorizes appmved work and no devlallon9 lhatefrom.Dovlaf/ons must rlrsi Aa aulhorized In wrifing from the <br /> Hullding of alal before being sulhorfzod under any c/rcumstence_T am the owner,ort am authorized by the awnerofthla property to perform the woric forwhlch appkaflon Is Made, <br /> and I comply wale the Slato Contraclors Law 99.27 ROW and 298.200A WAC. <br /> City of Everett Offfelal USB Onfy <br /> A PERMIT <br /> ikWV� <br /> 0WnffTAvtIiorTzo-d Ag6ttt 3lgneture `�l patue (l?49vlsdd 9/23 Log ) <br />