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04/06/2017 THU 12: 18 FAX Fae-b Water Heater4005/006 <br /> — <br /> SgOag <br /> PERMIT APPLICATION <br /> • <br /> BUILDING /MECHANICAL/ PLUMBING / SIGN I SPRINKLER/ DEMOLITION <br /> —Nt&—i. -_ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 93201 <br /> (P)423-257-8810 I FAX 425-257-8807 i(E)evareltaps@everettwe.gov I www.everettwa.gov/permlta <br /> (Blue or Black telt OW Please PROJECT SITiE INFORMATION ( l�J/�ab <br /> PROJECT SITE ADDRESS: gp ' A: J PROPERTY TAX#: fi� h►t C <br /> LEGAL for new conatructton: Short Plal/eubcilvlelon Lot No. (attach copy of long legal cleseripllon) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6 ff otie l .. TENANT NAME Of Commercial): '~r <br /> OWNER MAILING ADDRESS: s�rar=er (; rte/ hi <br /> 5 `? <br /> _. <br /> 1;In' ��� � <br /> WI STA7 ,�YT 2ff� !g <br /> OWNER PHONE: 1� (] OWNER EMAIL: . — 1 ii <br /> CONTRACTOR NAME; fA SI-- Ifll Al e. \-\- ....A-1-_ ,g_ <br /> CONTRACTOR ADDRESS: STREET 0-'+ 15 J C EX__ .Qk,AAA s 0- c_u),(i) <br /> Cr,-, ) --\-\- '- ,1_.- aTAT(: LAIh [Ip qpO'\ <br /> CONTRACTOR PHONE! ('--P S �0'6U'MD(- - t CONTRACTOR EMAiL:r f e. IT S ( i-tJO - AQow,, (,OVI1 <br /> CONTRACTOR LICENSE i#(REOUIRED):'FASTV)w0gL 13 C. CITY l)F EVERETT'BUSINESS LICENSE#(REQUIRED): 5b1-4 3 <br /> PRIMARY CONTACT: ❑ OWNER pm CONTRACTOR ❑OTHER(Pleaee Specify) <br /> CONTACT NAME: 1 CONTACT PHONE: 1 '3 <br /> \ f/IF-P3 r� �L 1 L- - CONTACT EMAIL: -P ' i- 5 o i -A-t,,ok, , i t , , c4:ym <br /> BUILDING PERMIT APPLICATION ii 1� <br /> Existing Use of Bul[U5 <br /> ing: h{ Contract Price of Work:$ I" 2( g <br /> Propoaed Use of Building: 5'f - Heat Source: ❑Gas �ElectrIc Dottier ,. _ <br /> Buildfn Type: FR-Detached ©SFR-Atl:ached ❑Duplex LIJMuiti-Famll -ft of Units: _ ❑Commercial ❑Industrial <br /> Type of Proect ❑New ❑Addition ❑Remodel CatRepair DT.I, USW ❑Sprinkler CiDemolltlon ❑Change of Uae <br /> DESCRIPTION OF WORK: <br /> vin o / re Q\, �ce tr <br /> ,O.ec i c w a--\-q- Vn.c afie/r <br /> ASSOCIATED BUILDING PERMIT# If a.,llcable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION , <br /> Typo of PrQJect: _New Addn /Alteration ,Repair Type of Project: New Addn Alteration Repair <br /> Fixtures List. (Mires,,,...... Fixtures List Fixtures FlYtr01e9 Llat Of Fixtures Fixtures es List ofFixturos <br /> A/C ' r Handlln0 Units Het Pump Toilet Backfiow Preventer(Inside Bldg) <br /> Force•Alr Systems Chit Healer Bathtub_ Urinal <br /> Gas 'iping Solley _Lavatory(Wash Basin) Drinking Fountain <br /> Wat Heater Refrigeration Shower Floor Drain <br /> Gas [replace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas -anee •uotin! Dishwasher Roof Drains <br /> Cloth. D% r- 'ooku.s • er: /'�� Clothoa Waeher . Medical Gas <br /> Range Hood / I J Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLL"'R I SUP E",SSIO 1%1%M <br /> -- _ <br /> eiemlcal ori o.of Heeds <br /> ACKNOWLEDGEMENT.'I havo reviawad this application and confirm the information contained herein is true end correct.Work done pursuant to this permit must comply with <br /> current federal, slate,end local law,The granting of a permit only authorizes approved work end no davlations therefrom.Deviations must first be author/zed In writing from the <br /> Building 0710la1 Were being authorized udder any circumstance.I em the owner,or/ern authorized by the owner of this property to perform the work for which application is made, <br /> and i comply with the State Contractors Lew l0.27 RCW and 220 200A WAG <br /> City of Everett Official Use Only <br /> \c4d��� ( � PERMIT ! ,` i i i ; <br /> Own uthor ze Ag Signature Date (Revised 9123/2616) <br /> I <br />