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05/18/2017 THTJ 14: 14 FAX Faat Water Heater 0005/006 <br /> 0 353 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL,/PLUMBING i SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)429-257-0910 1 FAX 425-257-8857 I(I=)evareltaps®everettwa.gov I www.everettwa.gov/permits <br /> Blue or leiack Ink Only Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5I 2-2N'2 PROPERTY TAX#: I O <br /> 1.FGAL for new conatructlon: ShortPtaUeubdlvlalon Lot No. (attach copy of icnp legal dasoription) <br /> CONTACT INFORMATION <br /> OWNER NAMF: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ` <br /> cnY STATIELZA zlr <br /> OWNER PHONE: LAPSOWNER EMAIL: <br /> CONTRACTOR NAME: EASTB'�AThiC- <br /> CONTRACTOR ADDRESS; STREET <br /> rr ,, CITY D STATE 'LIP 1 <br /> CONTRACTOR PHONE; CONTRACTOR EMAIL: 2+m rTS IU D <br /> CONTRACTOR LICENSE#(REQUIRED); S CITY OF EVERETT BUBINEBS LICENSE#(REQUIRED):5NS 3 <br /> PRIMARY CONTACT. ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: Y CONTACT PHONE: <br /> CONTACT EMAIL: VKI tt,)a C," <br /> BUILDING PERMIT APPLICATION <br /> 1 xlslfn Use of Building: Contract Price of Work:$ .S <br /> Proposed Use of�lB�ulldin : Weat Source: as ❑Electric ❑Other <br /> Bulldin Type: pn.>FR-Detached ©SFR-Attached ❑Du LAX 1JMul11-Famll -#of Units: ❑Commerclal ❑Industrial <br /> _Type of Pro act: ❑New ❑Addition ❑Remodel XRePair LIT,1. USI n ❑S rinkler 00omolitlon MChan a of Use <br /> DESCRIPTION OF WORK: 1 ^ <br /> /�SSOCIgTED BUILDING PERMIT# If a Ilcable; <br /> M12CHANIC L PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New AddnAlteration ,_Repair Type of Project: _New __Addn _Alteration _Jkepatr <br /> FI u f List of Fixtures Fl Utes Lfat of Fixtures Flxfures Llat ofFfxtures Fixtures Ltst of Flxtu <br /> A/C--Air Handling Units Heat Purnp Tollet Backflow Pravent nslde Bldg) <br /> Forced Air Systems Unit Healer Bath Urinal <br /> GaB PIping Boiler LAValory(Wash Basin Drinking Fowftaln <br /> Water Heater Refrl erstlon Bhower Floor Dr <br /> Gas Flre lace Wood Stove Kitchen Sink&Disposal ©tea Tra <br /> Gas Range Ducting Dishwasher RW Drains <br /> Clothes Dryer Hookups Other. Clothee Washer . ed Gas <br /> Range Flood Water Heater Other <br /> Exhaust Fan Sink S®rvie0/B0r1Mo etc. Other: I <br /> SPAN �SS10 1fSTImM i <br /> emits!or W A.of Heads <br /> ACKNOWLELPCEMFNT•1✓lava roviewed this appllcallon and conhrm the Information confalned hereht Is(rue and correct Work done pursuant to this permit must comply with <br /> currant federa),stsla�and local law.The granting of a permit only authorizes approved work and no deviatlons(horelforn.Devleflons must first be authorized in wrking tram the <br /> Sullding Offkial beton being atilhortZed under any cmicunistance.I am the owner,or i ant authorized by the owner of this property to perform the work for which appkallon 14 made, <br /> and I comply with the State Conbaclors Law 99.27 RCW and 298.200A WAC. <br /> City of EveMe ONfolal Usu Only <br /> A LCUb �' �-� �' PQM S - C)q 9--1 <br /> OwnWAUthorTzO Agbw signature Date F7avPe e 9 <br /> I <br />