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04/25/2017 TUE 10: 35 FAX Fast water Heater U008/008 <br /> 8 1 1 33 <br /> (4re-frPERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING / SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-0810 I FAX 425-257-4157 I(E)everetteps©everellwa.gev I wnvw-everettwe.govlparmlls <br /> (woo or Block Ink Only Please) !} PROJECT SITE INFORMATION rj�y /' <br /> PP.OJECT SITE ANIDRESS: (0.3 MtiGJNT) PROPERTY TAX#:JOD (p c(/t/f�/�OO Cf D� x <br /> LEGAL for new construction: Short Plat/subdivision Lot No. , (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME; I Ai A L d 4- -•„ k TENANT NAME(If Commercial): --- <br /> OWNER MAILING ADDRESS: srneer 1.230 A. r N De--- 5 C <br /> CITY f j T^.__ <br /> I '74 5TATE J ZIP -/fZ 3 <br /> OWNER PHONE: pP1P �`-f i ] I OWNER EMAIL: — l <br /> CONTRACTOR NAME; fA ST Vi :1g, \-1-?,....4--c-- _- - - <br /> CONTRACTOR ADDRESS; sTeEET `1...Th 15 N Ck€K� ,41-,„-T.{,--,--sG 1 D( <br /> erre Z t 1_, srrATE ll1 ` a'P g c Q 1 I <br /> CONTRACTOR PHONE: —!�S �0?7\ -"0< 7CONTRACTOR EMAIL:P't�.W\ ITS, o �pls)-u0O I,2 .-- . GCv1 <br /> _CONTRACTOR LICENSE#(REQUIRED):-ps-5r\A} \-)-0\1--1 3C. CITY OF EVERETT BUSINESS LICENSE trI(REQUIRED):5bL15 3 <br /> • <br /> PRIMARY CONTACT: ©OWNER (14ONTRACTOR El OTl-ER(Please Specify) <br /> CONTACT NAME: \ A:1-13 -\ L G CONTACT PHONE: q J g '2 L <br /> r - ul_ CONTACT EMAIL: tWl l'S ! ; tak. ' L I$ire. }'•, Ci(Wil <br /> BUILDING PERMIT APPLICATION <br /> AG- Ar <br /> Existing Use of Building: • Contract priceof Work: ., ••- -- <br /> Proposed Use of Building; PZ Heat Source: 10A eas ❑Electric ❑Other -*- <br /> Building Type: R-Detached ©SFR-Attached UDuplex ClMulll-Family-#of Units: ©Commerclal Cllndustrlel <br /> Type of ProJecL ONew GAddition ❑Remodel 3gfRepair OT.I- CISign ❑Sprinkler ❑DemoIIUon Change of Uso <br /> DESCRIPTION OF WORK: <br /> ie,\IY) D\J`C / r e Lip\A.Le', A-S tA)0,-.\-e)r V\ c ate-i--- , <br /> ASSOCIATED BUILDING PERMIT#(If eppllcAble): <br /> MECHANICAL PIERMVIIT APPLICATION PLUIVIBINO PERMIT APPLICATION <br /> 'Type of ProJoct: _Now Addn _Alteration Repair Type of Pro e • New Addn _Alteration Repair <br /> Fixtures List of Fixtures ^plx#tures List of Fixtures Flxlurras 1st of Fixtures fur s List of Flxt fes <br /> A/C-Alr Handling Units Heat Pump Ti et Backflow Prover r(Inside 131d ) <br /> Forced Alr Systems <br /> Unit Heater II <br /> Urinal <br /> Gas PI•In• Boller avatory(Wash Basin) a inkln. untain <br /> Water Hester Refrigeration ...bower Flo+ ts ain <br /> Ges Fireplace Wood Stove Itchen Sink&dla.osal .as. Tra. <br /> Gas Range Duoting a lehwaeher .Roof Ore ,a <br /> Clothes Dryer Hookups Other: C•thes Washer . Medical Go, <br /> 1 enge Hood Wa : Other: <br /> - Exhaual Fan Sink( = T op/etc.) - Other: <br /> SPRIN. • - ' - • -!~SSIO - :T>EM <br /> r emfcel or Water------ No. of Heads <br /> ACKNOWLEDGEMENT/have reviewed this appllcal/on and conflim The Information contained herein Is true end correct Work done pursuant to this permit must comply with <br /> current federal,stale,end local law.The granting of a permit only authorizes approved work end no deviations Therefrom.DevIation8 must first be authorized In writing(tom the <br /> Bu!lotng Official batons being authors ed under any circumstance.1 em The owner,ort am authorized by the owner of this property to perform The work for which 9pp/lcalico Ix made, <br /> and 1 oomply with(he Stele Contractors Lew 18.27 RCW and 2P6.2004 WPIC <br /> CHy or Everett Official Use Only <br /> 41 SA-VI <br /> PERMIT <br /> a6n <br /> I,, 1 <br /> Own: uttler zo. Ag•• signature Date -(Revised 0/23/2016) <br />