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08/10/2017 THU 11: 56 FAx Fast water Heater Ia1006/007 <br /> Dcy;isS <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL I PLUMBING /SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320o CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-267-8810 1 FAX 425-257-8967 I(E)everettepeceverettws-gov I www.everettwa.gov/permlta • <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION ^7� <br /> PROJECT SITE ADDRESS: qg .C? k) lAiI I _DK. I PROPERTY TAX df: r N �7 O�"Dd o?�(J(J <br /> LEGAL for nowconetruoNon: Shalt Plat/subdivision Lot No._ (attach copy of long legal description) <br /> - �•-�• <br /> CONTACT INFORMATION <br /> OWNER NAME Gi:,44i CAA A ■ &AA._/` iii aA TENANT NAME(If Commercial): ,�- <br /> OWL.-lit/ <br /> NER MAILING ADDRESS: erneer D671 , i(/) 1D)° <br /> / p' ? <br /> owl. �Ar'L <br /> / s Vt/STATE am DJ <br /> OWNER PHONp •�'E: � c3 Qlj <br /> 4 2- OWNER EMAIL: <br /> CONTRACTOR NAME; f �]i- 1n1 I)- .fs, 1--` lei <br /> CONTRACTOR ADDRESS: ameer >\I'15 N CNQa- 9 tslikA S C 1 D(p <br /> CITY Z DTA rf i/1,..1.., • <br /> 8tATE . I ziP / ♦rrI 1 <br /> CONTRACTOR PHONE: (-15" 0 , -i•: CONTRACTOR EMAIL: IF V 011T S 14 I. �"1 J/.6.4 ' -kW.. t <br /> ^ <br /> CONTRACTOR LICENSE#(REQUIRED):fA-s Vyw\-t�l9 ?C CITY OF EVERETT BUSINESS LICENSEt{(REQUIRED)5`1 3 <br /> PRIMARY CONTACT: 0 OWNER (IrCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: nq CONTACT PHONE: L i a s Le, -9--Ds-t...1 <br /> \CA- II V� CONTACT EMAIL: RArvvots silo ire,r• C/01/11 <br /> BUILDING PERMIT APPLICATION <br /> I iJi <br /> __ = r ` Contract Price of Work:$ <br /> Pro•osed Use of BuiIdln.: igi =_ • GGas EElectrlc Goutier _ _ -* <br /> 9ulldln! •e: Ow.•-R-Uetachad ISFR-Attached 0Du.tex OMuIt1-Pamll Oaf Units: GCommerclal IDlnduetrtal <br /> T •a of Pro act: ❑New OAddltlan ClRentodel Li Re.air OT.1. 031.n US•rinkler CI Demolition EiChan•e of Use <br /> DESCRIPTION OP WORK: <br /> fm ,,VV) 0\IL / re,p\ ce Co- s w ak-e \A c a,--te.r <br /> ASSOCIATED BUILDING PERMIT# If a-•Ilcable: <br /> _ MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION .. <br /> Type of Project: ___Now_ Addn _Alteration _Repair Type of Project: New _Addn -„Alteration _Repair <br /> Fhrturea f <br /> List of Fixtures Fixtures List of Fixtures Fix u:_ List of Flxtu Fixtures List of! • roe <br /> A/0 -Air Handling Unite Heat Pump Toilet Backflow Preva, r{Inside Bldg) <br /> Forced Air Systema Unit Healer Bathtub Urinal <br /> /`� Gas Pipinsl Boller Lavatory(Wash Basin) Drinking P.'Main <br /> — <br /> ) Water Healer Refrigeration Shower Floor D =n <br /> (-1" Gas Fireplace Wood Stove Kitchen Sink&Dle.osal ‘ -_==Tra._ <br /> Gas Range Dusting Dishwasher - -Dralne <br /> Clothes Dryer Hookups -I Other; _ Clothes Washer _ edit: Gas <br /> Range Hood Water Heater Other: - <br /> - <br /> Exhaust Fan nk ServiceiSar/Mo•/etc. Other: <br /> SPRIN _ RlR! - igSSIO—t ..SafsTLM V <br /> 1 emlcal or W rr .of Heads -- - <br /> ACKNOWi.EOGEM N7:/have reviewed this application and confirm the Informal/on contained herein le true end correct:Work done pursuant to this permit must comply with <br /> current federal stelae end local law.The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Buffering Official before being authorized under any circumstance.I am the owner;or i am authorized by the owner of thin property fa perform the work for which application fs made, <br /> end i comply with ilia State Contractors Law 18.27 ROW and 255•200A WAG, • <br /> City of eVerett Official Use Only • <br /> 4' ' A 10 1 AT, 0 --/9- PERMIT# 1 --.7 (:), .......ty2,2,7 <br /> ,A„,,,. i _ 1,...4.-.41' -4. : <br /> Own' 'uthorze:Ag- Signature - Date (Revised 9/2$2016) <br />