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01/24/201$ WED 13: 41 FAX Fast Water Heater 1&003/006 <br /> 87)L5—q55- - <br /> . <br /> PERMIT APPLICATION <br /> _ �,yam"" BUILDING I MECHANICAL 1 PLUMBING/SIGN!SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8814 I I AX 425-257-8857 I(E)everetteper?leveretlwa.®ov I www.everiethrva.gov/permits <br /> Blue or Block Ink Orap Please PROJECT BITE INFORMATION <br /> PROJECT SITE ADDRESS: D I 4 I P PROPERTY TAX#: ► NAi D D lb b <br /> LEGAL for new construction: Short PIatleubdlvIafor Lot No. (attach copy of long legal desorlplion) <br /> CONTACT INFORMATION <br /> NMIIMIMMOINIO <br /> OWNER NAME: ST v i vg..t c,E TENANT NAME(If Commercial): - • <br /> - <br /> OWNER MAILING ADDRESS: emu N V l --n)1.� VL Q Ave <br /> oov V` l BTA7E LA) t'1/4ZIP. I g2-61 <br /> Oar HONE �a ' ( S ,L.t b Q� NER EMAI <br /> CONTRACTOR NAME: fA ST in1(�'j\ OWe �S-A'T / <br /> CONTRACTOR ADDRESS: m3•rneeT 1 F P 6 NNS C. 1 D(/' (� /�I 1 <br /> cnr Q sTATE i LIPS z,„ ` " I U ` 1 <br /> CONTRACTOR PHONE: v60 S (P-6�,.P-1-03k-it, CONTRACTOR EMAIL:Q' lm IT S �(01.) -i.fLDY� <br /> CONTRACTOR LICENSE#(REQUIRED)_'�prS-w\-- c V ri 3. CITY OF EVERETT'BUSINESS LICENSE#(REQUIRED)51)1153 <br /> PRIMARY CONTACT: ❑OWNER (CONTRACTOR ©OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lf // ' Icy,, �-1 S1- <br /> 1(14-17j � CONTACT EMAIL: Q-P�t1a1-s if +-C' �,s1 `e,r ! -4�-�, Grivi l <br /> BUILDING PERMIT APPLICATION <br /> `, Existin, Use of Bulldirl•: . r' Contract Price of Work:$ S- �� <br /> Proposed Use of Building: S1'f Heat Source; ,',Gas ❑Electric ❑Others s_ <br /> Building Type: gPR-IDetaohed ❑SFR-Attached ❑Duulex IJMulti-l=amiI -#of Uhlts: ❑Commercial ❑industrial <br /> Type of Prefect CONew CIAddltion ❑Remadel kRepair ❑T.1. Osign CIsprinkier ClDamolitfon Cl Change of Use <br /> DESCRIPTION OF WORK: <br /> fvin ove, / y-e,p\Ace Gs <br /> waA-elr VA,E o,-ter <br /> ASSOCIATED BUILDING PERMIT*Of applicable): _ _ <br /> MECHANICAL.PERMIT APPLICATION , PLUMBING PERMIT APPLICATION <br /> Typo of Project: _flaw _ Addn _Alteration _Repair Type of Project _New ,._,Addn __Alteration __Repoli' <br /> #of <br /> Fixtures UM'of Fixtures PiXtkres Llot of Fixtures Fixtures list of Fixtures Fixtures ' Llst of Pixt •s <br /> AIC—Air Hance Units Haat Pump Toilet Backflow Preys =r_(Inside Bldg) <br /> Forced Alr Systems Unit Heater Bath • Urinal <br /> Al Gas PI•in• Boller <br /> L=•afo Wash S= Drinkfn. F: ntaln <br /> Water Heater Refrigeration • owar Floors =in _ <br /> GEIS Hie.lace -- Wood Stove Itchen Sink&Disposal r =ae Trap <br /> _tate Rana® Ducting It Ishwasher oof Drains <br /> Clothes Dryer Hookups _ _other; V , lothes Washer Medical Gas <br /> Ralle Hood ':ter Heater ••ther: <br /> Exhaust Fan 1.. -rvlce/B= _. etc.), Ot = . <br /> . Sin <br /> SPRIlil -S IIS$!Ot 1f$TeM - <br /> . <br /> ( iemical or W .of Heads <br /> ACKNOWLEDGEMdNT./have reviewed this application end confirm(ha lnfwme/Ion contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state.and local law.The granting of a permit only authorizes approved worn and no deviations therefrom,Deviations moat firs/be authorized In writing from the <br /> Building Oftllel Wale being authorized under any circumstance_I am the owner,or!am authorized by the owner of this properly to perform the work for which eppiloeflon is made, <br /> and 1 comply with the State Contractors Lew 99.27 ROW and2®a2AOA WAa <br /> city of Everett Official Use Only <br /> .41 ,.A! ` , �_aLi - (g 1 \? c . - 09(4 <br /> Own` •uthorze.Ag'1.tSlgnature Date (Revised 9/2S/2016) <br />