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01/03/2018 WED 12: 24 FAX Faet water Heater 0012/012 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL I PLUMBING / SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 90201 <br /> (P)425-257-8810 I FAX 425-257-0857 I(E)everattopsoavereuwe_gov 1 www.everettwA.goV/permIts • <br /> :.Slue or Black lw,k Onl Please PROJECT srr INIP®RtMA4'ION , <br /> PROJECT SITE ADDRESS: / i I PROPERTY TAX#: j1, ,�' 1 '� II IT� <br /> • <br /> LEGAL for now construction: Short Fist/subdivisionLot No. _ (attach copy of long legal description) q <br /> CONTACT INFORMATION <br /> OWNER NAME: C j ki -....111-- J CV\\--% nTENANT NAME(If Commercial): .— <br /> OWNER MAILING ADDRESS: erREEF Ct 0-110`-l F\�f _ <br /> crrY ���f1 `'� r , srp,ic CAJ Pr zJr 'agri S1 <br /> OWNER PHONE: ( 9( I �L 1 _ OWNER EMAIL: <br /> CONTRACTOR NAME; f ST `AJ p\-ie t"l N'-1-' ,'R <br /> CONTRACTOR ADDRESS: STREET 1 _17 PAM }ti- /',,_1 (�''„ <br /> crry v v ��L 8TAATHWA' ZIP G D D I I <br /> CONTRACTOR PHONE: (-.1 1,3 , 0 . CONTRACTOR EMAIL: f V.,Wl ITC * I. -1-vJ/t✓ \A.p/-1i1', 0 <br /> CONTRACTOR LICENSE##(REQUJRE1D): A sr ,t)\ 1 j(✓ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)51)115 <br /> PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: \/,,6,--ii ` CONTACT PHONE: �'/q�� ,3� ��/ <br /> �^ -rl �� CONTACT EMAIL: pvY Wl,l"� ,"AS-i-in)�t- iii Al¢-I e.r. £'OVl'l <br /> BUILDING PERMIT APPLICATION <br /> 1=xisting Use of Bulldire (5'r Contract Price of Work.$ <br /> Proposed Use of Duilding: sp.-K.. Heat Source: 110as gElectrlc 0Oiher T - <br /> Buildln_g Type: #SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: L ICommerelal• Dindustriel <br /> Type of Project ❑Now ❑Addition ❑RemodelRepair PTA. ❑Sign ©Sprinkler ❑Domolitlon ❑Change of Use • <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED eUILDIN©PERMIT#SII'applicable): <br /> MECHANICAL PERMIT APPLICATION —_ PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn __Alteration _Repair Type of Project: __Addn Addn ___Alteration __Repair <br /> Fixtures If <br /> List of Fixtures Fprtura9 List of FI res *°f List of Fixtures °f List of Fixtures <br /> F/xtures Fixtures <br /> A/C— , -_• line Units Hoot Py p Toilet I3ackflow Preventer(Inside Bldg) <br /> Po ed Air S ate - UnJt FieoterBathtub _ Urinal <br /> tee PI•In! Iter Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Re frI•eratlon shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Traj <br /> Gas RaneeDuctln Dishwasher Roof Dralne <br /> C oihos Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ranee Road 116. Water Hester Other: <br /> Exhaust Fen • 6111. (ServIce(Bar/Map/etc.) Other ._ ' <br /> YSPRIN PP SSIO STem - <br /> 1 emicel or W: a:1 , of Heade <br /> ACKNOWLEDOEMMNT:/have reviewed this application end confirm the Informellon contained herein is true and correct.Work done pursuant to this permit rnust comply with <br /> current faderai,state,end local low.The granting of a permit only authorize&approved work and no deviations therefrom.Deviations must first De euthorlrad in writing from the <br /> Building Official before being aulho,fzed under any circumstance.I ern the owner,or I em authorized by the owner of this property to perform the work for which application Is made, <br /> end i comply with the Slate Contractors Lew 18.27 ACW and 289.200#WAG <br /> City or Everett O7rciel Use Only <br /> . ►� ql <br /> 3 r . pEI � ) - o20 <br /> own uthor ze Ag Signature Dote (Revlso 12 Id <br /> ) <br />