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08/10/2017 THU 11: 55 FAX Fd5t Writer Heater 0005/007 <br /> PERMIT APPLICATION 19P11 <br /> BUILDING I MECHANICAL,/PLUMBING I SIGN I SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 36201 <br /> (P)425-257-9910 I FAX 425-257-8857 1(1-)evorotteps@everattwe,gov I www.evereLiwa.gov/per•tnits <br /> Blue Or Black Ink Only Pleases PROJECT,SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5v PROPERTY TAX#: G <br /> LEGAL for new conatrucflon; Short Plotfeubdlvlalon Lot No. (attaoh copy of long legal description) <br /> CONTACT INFORPAATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smrrr E <br /> GrrY STATE Wr l ZIP <br /> OWNER PHONE; ulDs OWNER EMAIL: — — <br /> CONTRACTOR NAME; S� <br /> CONTRACTOR ADDRESS: STREET s <br /> CrrY STATE ZIP I <br /> CONTRACTOR PHONE: vfI)s CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REaUIREn);� `C,� w 1�1 G clTY OP EVERETT BUSINESS LIcr=NsF 44(8EQU,RED) Lf:53 <br /> PRIMARY CONTACT: LI OWNER CONTRACTOR, ❑OTFIER(Please Spaclfy) <br /> CONTACT NAME: CONTACT PHONE: L I <br /> CONTACT ENTAIL: .e�(yJA,'J- JS <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building; Contract Price of Wark;$ <br /> Pro 050d Use of BOW Heat Source Das ❑Eleciric 00ther <br /> Bufldln Type: FR-Detached ❑SER-Attached 010upix E]Multl-Famli -#of Units: ©Commercial ❑IndusIrlal <br /> pa of Pro ect ❑New ❑Addition ❑Remodel Re elr LIT.►- L]S1 n ❑S rinkisr ❑Demolition OChan a of Uee <br /> DESCRIPTION OF WORK: <br /> F,P,W) D�e� / �-e��0,C e—, C� s <br /> ASSOCIATED BUILDING PERMIT#flf applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project, —Naw _ Addn _Alteration upalr Type of Project: ___New __Addn _Alteration —Repolr <br /> F/xtu as Llsf of Fixtures Ftxtu e9 List of Futures Fixtures I Ist of FWuraa FIMr°t as List of Fl urea <br /> A/C–Air Handlino Units Heat Pomp Tofl Backflow Prsv er Inelde eld <br /> Forced Air Systems; Unit Heater E3 tub Urinal <br /> Gas Piping Boller vato Wash Basin Dr[riking F untaln <br /> Wfltar Heater Refrl ®radon hewer Floor Ain <br /> GaB Fireplace Wood Stove Itchen Slnk&pia veal r se Trap <br /> Gaa Range DuctIng Dishwasher rains <br /> Clolhea Dryer Hooku e Other: Clothes washer Medica s <br /> Range Hood Water Heater Other; <br /> Exhaust Fan Slnlc Service/bar/Mo /etc, other: <br /> 1�6SP IN E8SI0 TVI <br /> eMICal or W to of Heads <br /> ACKNOWLEDGEMENT.f have,rovfawed this application and conflun the Informallon contained herein Is true and correct.work done pursuent to this permft muss comply with <br /> currant federal,staler and focal taw.The grantfng oto permit only aalhortzos approved work and no dev/ttdons fhvrefrom,Deviations must first be suthorwd/n writing#om the <br /> Dultd/ng Off/clat bef&O Doing authorized under any circumstance.I em the owner,or I am authorizsd by the owner of thfs properly to perform the wodt far wh/ch epplImIlon is made, <br /> and/eompfy with the Skits ContvaclorS Low la 27 RCW and 20..200A WAC <br /> City or Evetsft Offlclal Use Only <br /> �141 A PERMIT <br /> Own&TAuthorTzod Ag 9(gnature ate (Revised 9123120fB) <br />