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10/30/2017 MON 15: 04 FAX Fast water Heater ► 007/008 <br /> Ivo v 5a- <br /> PERMiT APPLICATION <br /> �.1011114IPIA BUILDING (MECHANICAL/PLUMBING/ SIGN/SPRINKLER/DEMOLITION <br /> n CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 99201 <br /> (P)425.2574810 I FAX 425-257-8x57 I(E)everettepseeveretlwa.gov I www.everettwe.goV/permlts • <br /> (Slue or Black Ink Onl Pleas PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'Li DVA4n4 P I C pg. PROPERTY TAX#: f7 b 11 bO _O y <br /> LEGAL for new Construction: Short Platieubdlvfolon Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: P 4 V iffigir TENANT NAME if Commercial): <br /> OWNER MAILING ADDRESS: smear L� I S I 1 P• <br /> CITY f� L s STATE V ZIP A _ja• <br /> OWNER PHONE:(.4, _ i"( Db�S OWNER EMAIL: .,'---- <br /> • <br /> CONTRACTOR NAMEI 'fA SI' Vd rY(. Y1 0(' l 4 • <br /> CONTRACTOR ADDRESS: smear 01"l'rj 1J Off . P $ =N- C 1 n(p <br /> cot # <br /> _L- amore ZIP . 11 <br /> CONTRACTOR PHONE: (--a 5 to \j SAA CONTRACTOR EMAIL:F'E I.1/y) 1-1-s P SirvJOkv ( !a-1fir. (Ail <br /> CONTRACTOR LICENSE#(REQUiRED):f \A)��Li R Be__, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)5O L/53 <br /> PRIMARY CONTACT: 0 OWNER ( rCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: p5--CONTACT PHONE: ^ �. � g 3L <br /> K�- `r I L-- CONTACT EMAIL: 1. ,t--' r ; LO/ k 1 <br /> BUILiDING PERMIT APPLICATION <br /> 14 Existin Use of Sulidln : Contract Price of Work: <br /> Proposed Use of Building: S Heat Source: Gas I:Electric ❑Other <br /> Building Type: R-Detached DSFR-Attached ❑Duplex LDMultl-Family-#of Units: ❑Comrnercial ©Industrial <br /> Type of Project: QNeW EIAcldItion CIRemodel OciRepeir AT,I. ' tJSIgn DSpilnkler °Demolition DChenge of Use <br /> DESCRIPTION OF WORK <br /> jinn d\le / 1(4\A•ce MS w OL• ear C od-•e,‘-- <br /> ASSOCiATED BUILDING PERMIT 0(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMVIS1NG PERMIT APPLICATION <br /> Typo of Project: _New_ Addn _Alteration ,_,Repair Type of Project: __New _Addn�1itaratlon Repair <br /> #of List'of Fixtures #°l List of Fixtures °f LI °f List of Fixture <br /> Fixtures Fixtures Fixtures Fixtures <br /> - <br /> A/C—Air Handiln9 Units Heat Pump Tel • Backflow Preventer fnslde Bid! <br /> Forced Air Systems - _Unit Floater __B: htub Urinal <br /> Gas pipe Boiler . ,vetory(Wash Basin) Drinking Four = n <br /> `Water Heater Refrigeration •hewer Floor Ora• -- <br /> Gas Fireplace Wood Stove itchen Sink&Disposal t• =as= rap <br /> Gag Ranke Duotlnj Dishwasher - R.• Ureins <br /> • <br /> Clothes Dryer Hookups Other a othee Washer _ ,edlc: cas <br /> Range Hood =ter Heater Other: <br /> Exhaust Fan Sin (Service/iar/Mop/etc. - - ' <br /> , •• Other: <br /> SPRIN _ _ _ ESSI'O - • 14 <br /> v emloal or . ..of Heads <br /> e �' _ <br /> W< <br /> AOKNOWLEDGEM N't I have reviewed this application and confirm the information contained herein Is true end correct Work done pursuant to this penmit must comply Korth <br /> current federal,stale,end local law.The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must!/rsf be authorized In writing from the <br /> Building official Coble being anthorlzed under any cfrcwrnstance.I am the owner,or/em authorized by the owner of this property to perform the work tor which application is made, <br /> end i comply with the Stale Contractors Low 98.27 RCW and 29520OA WAC. <br /> City of Everett Official We Only <br /> ` • 30 <br /> # 1 <br /> 7 PERMIT* <br /> Own''•uthor 504 Ag Signature Date (Revised 8/23/2096) <br />