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05/18/2017 THU 14: 14 FAX Fa_t water Heater 003/006 <br /> 814/31 <br /> (Ora"- PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)423-257-8810 I FAX 425-257-8657 I(E)everettops(jeverettwa.gov I www.everetlwa.Oov/permit$ <br /> (Blue ar_Blenok ink_Only Please) PROJECT SITE INFORMATION <br /> A.PROJECT SITE ADDRESS; 01 g t� 5T" E(� TPROPERTY TAX#: �)► bt7 t OODo = D . <br /> LEGAL.For new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION _ <br /> OWNER NAME: 0 L 5 IP p 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srgeer I ` 11`i'W 5T w <br /> MY �./ • 143 STATE L G' - zIP $ . <br /> OWNER PHONE: a' . (1 OWNER EMAIL: <br /> CONTRACTOR NAME: ff Si- VI Al-el., .13PrT3 <br /> CONTRACTOR ADDRESS: STREET 11�I5 N CN1Q. Pky�u S J ( \�.(p <br /> owe D,4-A VeTATs A / ZIP , I <br /> CONTRACTOR PHONE: pts 4Q?l.P 91)31-1 CONTRACTOR EMAIL:FT Q.VYI ITS C AS}uJI O C'r• tOYIi <br /> CONTRACTOR LICENSE#(REQUIRED):�FA'STINVO1-tc1'-4 R SC, my OF EVERETT BUSINESS LICENSE#(REQUIRED):50 455 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: �, L1 CONTACT PHONE: - a5 '3 , <br /> .,4-11j 7 V� CONTACT EMAIL: teii yV1�ItS 't" 1pr" GY-�"r1 A t)/1-4•Qir, c,OINI <br /> BUILDING PERMIT APPLICATION W <br /> Exletln9 Use of Building: S f _ $ I _ _ <br /> Contract Price of Work: �' <br /> Proposed Use of Sultdin�: SF-K. `Heat Source: (Nes DEleclric DOther 4fr <br /> Building Type: FR-Detached OSFR.•Attached ODuplex IJMultl-Family--#of Units: ©Commercial Dindustrlal <br /> • <br /> 'type of Project: ❑New OAddltion !]Remodel 04Repair IIT.I. C°Sign °Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> V)(t Ove / (e kiP\A C6 G')kS LA)ak- \A c oct <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL.PERMIT APPLICATION PLUMBING PERMIT APPLICATION • <br /> Type of Project: ,__New_ Addn _Alteration „_Repair Type of Project: New __Addn __Alteration _Repel, <br /> *of — List of Fixtures #of Llai of Plxtut�5 II of t of F/xtu of List of H es <br /> Fixtures Fixtures Fixtures <br /> ures Fixtur®s <br /> AAO—Air Handling Units Heat Pump T et Backflow PreVee, .r(Inside Bids) <br /> Forced Air Systems Unit Hester <br /> athttib T Urinal <br /> Gas Piping !Seller Lavatory(Wash sauna) Drinking untaln <br /> WaterD Heater Refrigeration Shower Floor P.• am <br /> 1 <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal r- :ase Trap _ <br /> Gas Range Ducth j Dishwasher 'Roof Drains . <br /> Clothes Dryer Hookups Other: Clothes Washer dlcal Gas <br /> Rewe HoodWater Heater Ot : <br /> • Exhaust Fan -- . _ Sink(Service/B plaits) Other. _ <br /> SPRIN)L Blit ESSION SYSTEM - <br /> I iemical or .of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application end confirm Me Info:merlon contained herein is true end correct.Work done pursuant to this permit meet comply with <br /> current federal,stere,end local law.The granting of a permit only authorizes approved work and no deviations thorefrom,Deviations must first be authorized In writing from the <br /> au/Ong Official before being authorized under any circumstance.I em the owner,ori em authorized by the owner of this properly to perform the work for which application Is made, <br /> end I comply with the Slate Contractors Law 1&27 RCW end 206.200A WAG <br /> City of EVerolz ONkaUseOny <br /> Own !Allot rodAgBther. <br /> . f -O <br /> . <br /> t?"/ //- <br /> - <br /> Date PelTvl S — V <br /> (Revised 8/2312016) <br />