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Feb 24 2017 01;44PM Washington Wa�r Heaters 8663757454 page 1 <br /> I� ���� <br /> ��Rmir,a�pL�cATtorv <br /> BUILDING/MECHANfCAL! FLUMBING J SIGN ! SPR(NKLER i DEMOLIi'!ON <br /> CITY 4F EVERETT PERNlIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,VtrA9820'1 <br /> {P)425-257-8810 � FAX d25-2S7-8857 �(El everetieps(devereriwa,gov� ww�nr.evereEtwa.gov/permifs <br /> (Bl�e ar Black ink Only please} PRpJECT SiTk INFORMQTIdN � . <br /> P�wecr si��Ao�aess: / � PRQP�RTY TAX#;0�83��aa�a pp <br /> LEG.t1L for new oonstruction: Short pla#lsupdivislott ~ Lnt No, <br /> _.,_, (attach copy ot iang legal deSCripUan} <br /> coNracr r��awHartoN <br /> OWNER NAME; ( �,, G J�f A''�Q T�NAN7 NAME(If Camm�rclalj: "' <br /> OWN�R MAILING ADDI�ESS: s�est Ip�a(� <br /> cnv �(/���' � STATE z�, <br /> owr���pHor�e: ��-�7fo�� 0�J �WNER EMAIL: (rLY!(C�LULU <br /> carR�acrnRr�,ann�: ���lti1G�TbN '►9- /2 �-l�7�2.s <br /> corvr�croR ao�rt�ss: s���Er t`tt y Z L l lv� ��'�, � �— C� U�C l�(j� <br /> cirr �.l�i.�Ulrl srA7� L.,(�� zia <br /> CONTRACTOR PHQNE: �Z J�b b,j- GON7RAC70R EMAiL: Y l�t L� C�YI� <br /> CONTRAC70R LICEf�lSE#(REQUIRED): �(I/�r��,� g� CITY OF EVF�tETT BUSIi+tESS 1,ICENSE#(REQUIRED): � ��� <br /> PRlMARY CONTACT: p p�/N�� q{�-r�,q�TOR ❑OTH�R{Please Spaufy) � <br /> CON ACT PiRh¢E' GONT/kCT PNONE: �„ .-�% 3`t t��/ <br /> ��-cc r �a.�t-�!S -7 <br /> CON7ACT EMAIL: (,tJ�(,tfl�.,����,R��p H��,,���,�,� <br /> BUILDCNG PERM17 APPI.�CATICN <br /> Existin EJse of Buildin ; � Coritract PriCe af Work:$ <br /> Proposed Use of Bulldi ; Heat Source: ❑Electric ❑Oth�r <br /> Buiidin 7 e: ❑S�R-Cetached � Attached �7Du lex ❑Multi-Fami! -#of lfnits: ❑Cornmercia! [31n na <br /> 7 eofProject: �1New ClAdditiort ❑Remadei ❑Repair ❑T,I_ OSi n OS rinkfer ❑Demolition DChan eof e <br /> DE5CRIPTIdN aF WQRK: <br /> �.-�-�_. .._... <br /> ���-�- ����- l�� Gl����B��G <br /> A59oCIATEO BUILD[NG PERMIT# if ap iica6le: <br /> MECHANICAL PERMIT APPLICA'f'10N PLUMBIN6 P�RMIT pppL�CpT�ON <br /> Type of Project: �New Addn Alferatian _Repalr Type ot Projeot: New Addn ,"Alteration Rapair <br /> #of � � T#of � <br /> List of Fi�xiures #of <br /> fiixtures Frxtwes L�st af Frxtures #of f.isf ot FlXtures Ltst of Fixtures <br /> Fixtures F3xtures <br /> AIC-Air Handlin Units Heat Pump Toilet Backilow Prevenfer tnside Bldg) <br /> Forced AiF S sfems Unif Heater BathEub Urina! <br /> Gas Piping Boifer Lavato <br /> Water Heater rY{Wash Basin' Drinking Fountain <br /> Refri eration Shower Floor Drain <br /> Ges Fireplace Wood Stove KiFchBn Sink&Dis osal Grease Tra <br /> Gas Range Ducfing Dishwasher Roof Dreires <br /> CIotF�es Dryer Hootcu s Other, Clothes Washer Medicat Gas <br /> Range Hood V�later Heater <br /> Eschaust Fan Other. <br /> Sink(ServicelBar/Nopietc.) Qther: <br /> 5PRlNKL�R I SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOtM EDGEMEN77l have re�lewed this applicairon and conlfrm the in(crmafion eantalned I;eraln!s true and cnnect Work done pursuant to this permr�musf camply wlth <br /> currant federa�,stete,and lvcallaw.The grartting of a permit only autl�orizes ap/xoved work and no devJations therefrom.DevlaCrons mwY�trst bs authorized m wr.'ling from the <br /> BuAd�g 07rcia/6efore 6elrtg autharized under any circumstance.1 am fhe awne�or 1 am autho�ize�by the ownerof th;s property to perfpim the work for which appJlcation!s madQ <br /> and 1 comply wlth fhe State Contracfors Ca ie,27 RCW 296.20QA WAC. <br /> • ` ��� ,J CFfy o/E've�ettOtfic/al Use Only <br /> �l � <br /> nedAuihorfzed Aflent Signature P�� `�� ! �� � <br /> Date (Revised 5l20/2016) <br />