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06/01/2017 THU 16: 25 FAX F$. t water Heater 1003/006 <br /> 01433 <br /> OilEnrPERMIT APPLICATION <br /> BUILDING /MECHANICAL.I PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-5910 I FAX 425-257-0057 I(E)overattaps®everellwe.gov I www.everetlwa.gov/permlte <br /> (Blue or Black Irak Only Pieaz o) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 1L'i T g)riktj AV E PROPERTY TAX#: 0)1i515OL 00=100 y <br /> LEGAL for new construction: Short PleUsubdlvIalon Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PCht\\I TD13 N I+ N 6 DA-1 <br /> NAME(if Commercial): <br /> OWNER MAILING ADDRESS: Traml_kr,41-- <br /> 11 Lfe cj pK V l , Q�/yy� <br /> ocm, J� s.,,,,WA-- Zm q (?lJ v l <br /> OWNER PHONE; _ 5 31.4 3. g OWNER EMAIL.: <br /> CONTRACTOR NAME; f2S'1 v)Al e. vs <br /> /�V_A.1 I , <br /> CONTRACTOR ADDRESS: sTREEr `L r N t/ Q Q Y.--UN-��"ll <br /> 5 - C I D(p JV�� y/� 1 <br /> CRY Z 01)-k �L STAT I /(` ZIP l Il D `' <br /> CONTRACTOR PHONE: —t S to'? i (CONTRACTOR EMAIL;PV Z al r S AP- ,SruJ t\e,r v o,,-\-ri1'', (,OYI/1 <br /> CONTRACTOR LICENSE#(REQUIRED): STAAM)N�1`-iS 13� ICITY OF EVERETT BUSINESS LICENSE rt(REQUIRED)5 X/53 <br /> PRIMARY CONTACT: (i OWNER (1CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: /� t'1 t� CONTACT PHONE: g 3L <br /> KA' j`'� , CONTACT EMAiL: (TANAl P ;, )/ -Ir ` 0.-t- . (jO <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buliding: • Contract Price of Work:$ 1Ili i <br /> Proposed Use of Building: Heat Source: OGas lectric IJOther <br /> Building Type: P FR-Detached USER-Attached DDuplex LJMuitl-Famljy-#of Units: ❑Commercial Dlnduetrlal <br /> Type of Protect: ONew ©Addition DRemodel XRepelr ]T_!. ❑SIgn ❑Sprinkler ❑Demolltion ❑Change of Use __ <br /> DESCRIPTION Of WORK: <br /> term o\ / re,V\A.0 -e -CL L w a"V- \AC after <br /> ASSOCIATED BUILDING PERMIT# If a.•Iicalule: <br /> MECHANICAL PERMIT APPLICATION PLUMBING_PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration �Rvpalr , Type of Project: New _,Addn _Alteration _Repair <br /> Fixtures <br /> List of Fixtures F/xturos Llat of Fl_ <br /> ,tea F/xtu f /-rat of Fixtures Fixtures of Plxtur os <br /> A/C-.Air Handling Units Heat P -p Toilet Backflow Preventer(inside Bldg) <br /> • FWF.041 4-7345-W05 U eater Bathtub _ Urinal <br /> Gas Piping .olior Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> I Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease rap <br /> Goa Range ting Dishwasher Roof Drains <br /> Glolhse Dryer H lis Othe. 'Clothes Washer Medical Gas <br /> anae I Water Heater Other: <br /> Exhaust Fan D Sink(Service/Bar/Mop/etc.), .. Other, , <br /> SIP RIMS". LS8IOjI M8T M - <br /> jt iemlc4i or W -of Heads <br /> ACKNOWLEDGEMMN7.I have reviewed this applloetlon and confirm the Information contained herein la true and correct.Work done pursuant to this permit must comply with <br /> currant were),state and local law The granting of a permit only authorizes approved work end no deviations therefrom.Devlftlona must first be eulhoNxed In writing from the <br /> Building Official before being authorized undareny circumstance,i em the owner,or/am authorized by the owner of irils property to perform the work for which application is made, <br /> end i comply with the Stale Contractors Law 18.27 RCW and 226 200A WAC <br /> m <br /> CIO!ofverett Official L/a Only <br /> . A .� , --iPERMIT# n Deo, 00(;) <br /> Own, •uthorze Ag-Itt signature Date (Re vrsed9/23/2015) <br />