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09/28/2017 THU 9: 40 FAX Faat water Heater fJ004/005 <br /> (Uti,)q ,_CY"-- <br /> 111:::°- PERMIT APPLICATION <br /> BUILDING /MECHANICAL /PLUMBING 1 SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> v 3200 CEDAR STREET,EVERETT,WA 98291 <br /> (P)425-257-a810 I FAK 425257-5857 I(E)evereltops .7everetlwa,gev I www,everetlwa.eov/perrrtite <br /> (Blue or slack Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6n� (rL�'kt!r�'� PROPERTY_ TALCf:� QJV <br /> LEGAL for new construction: Short PlaVaubdlvfalon Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0 , S it ° At Ad., TENANT NAME(If Commercial : �� �, <br /> OWNER MAILING ADDRESS: eraEu 9 a r)— - '� Li �a /�,y/ 7� <br /> —. CllY V ' A STATE �4— n' q/ -��J <br /> OWNER PHONE: _O 35 1 i OWNER EMAIL: — 1 <br /> — <br /> CONTRACTOR NAME, .rA S� `id Al C� t l�Ic"�'siI <br /> CONTRACTOR ADDRESS: eTREETI l�" TAP) 21,)).A $ <br /> iLI__ STATEl A Zlr+ <br /> — <br /> CONTRACTOR PHONE: (--'! s 0 , t D 1 CONTRACTOR EMAIL; . Z1.41 I T S ' ) 1.136a:A l -)frit-, 62_ <br /> CONTRACTOR LICENSE#(REcluIRED):���'S"�w�V�O-j 13(-- CITYOF EVERETT BUSINESS LICENSE NREQUIRED)O(453• _�� <br /> PRIMARY CONTACT: LI OWNER (CONTRACTOR EIOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �/LA .A.,p 1--D " I <br /> h•14� \/— -N-U _ CONTACT EIt7AJL: p..e VIyI�I" i <br /> _eks IIJQIAeAl'\1w,`rw, (A5Y!vi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: R Contract Price of Work:9 "WO' ' Proposed Use of Building Heat Source: as ❑Electric ❑Other <br /> Building Typo'. (:SFR'-Detached ©SFR••Attached ❑DupleX DMulti-Family-#of Unl s: ❑Commerclal ❑Industrial <br /> Type of Pruett: ❑NeW DAddition ❑Remodel LXRepaIr DT.I. l7Sl•n EIS•rinkler OIDemolitlon C1Chtinee of Use <br /> DESCRIPTION OF WORK: <br /> )VVZ. G4.S ill)a:-\-eAr \A <br /> ASSOCIATED BUILDING PERMIT#(lP 95 p " <br /> ppllcrtbie): <br /> MECHANICAL PERMIT APPLICATION PLUMAING PERMIT APPLICATION <br /> Typo of Proloct: New Ad ,_ <br /> Arian Alteration Repair 1 ..r Typo of Project: New ,Addn _AlterstIon Repair .. <br /> #of <br /> Fixtures List of Fi)ctures F1xtu <br /> xtUrea List of Fixtures F(xtu Lls F/xturos F/tg°mss List of F/xtu s <br /> NC Air Handling Unite n <br /> -- Heat Pump Toilet Backflow Prevent inside Bldg) <br /> Forced Air Systems Unit Heater 13athf b urinal <br /> • Gee Piping Boller Lav my(Wash Basin) Drinking FO iSteln <br /> AI Water Heater Reirlgeratlon Sho er leer Dr= <br /> Gas FireplaceWood Stove Kit en Sink&Disposal GI:a.a Trap <br /> Gee Range Ducting DI washer R•. •ralne _ <br /> _ _ Clolhea Dryer Hookups Other: 'GI(thes Washer _ edits as _ <br /> Range Hood W:ter Heater Other: <br /> Exhaust Fan Sin Service/Bar/Mo./etc. • , <br /> SPRIN LER-(-SLIP ESSIO ST IA <br /> Iemlcal or W 11e,of Heads <br /> A CKNO WLEOGEf d NT./neva reviewed 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 015 permit only authorizes approved work and no deviations therefrom.Deviations must first he authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner, or I am authorized by the owner of this property to perform the work for which epplicatlon Is made, <br /> end 1 comply with the State Contrectors Lew 1A27 RCW end 206.200A WAG <br /> nr—)9 <br /> City of Everett Official Use Only <br /> /-I/�1`` VW. g —�U r PER ` DC& <br /> Own uthorze AgBt�tSl nature p <br /> 9 ate (Revised 0/23/2016) <br />