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03/07/2018 WED 13: 04 FAx 425 415 6867 Fast Water Heater <br /> (2003/005 <br /> V ) I Ib(p <br /> 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 98201 <br /> (P)426.267.8810 I FAX 425-257-8857 I(E)everettopsaeverettwa.gov I www.everettwa.gov/permIls <br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION , <br /> PROJECT SiTE ADDRESS: ,)91)3 9 'C-riD R P PROPERTY TAX#: 06,553 I UD1 Qr) <br /> LEGAL for new construction: Short Plal/subdivieion _ Lot No. (attach copy of long legal deacriplion) <br /> �_ CONTACT INFORMATION <br /> OWNER NAME: A4) Q "/v TENANT NAME(If Cornmerclai): <br /> OWNER MAILING ADDRESS: STREET a � lG t ' — °U _ <br /> cnY gA bre .. .. -STATE SVG" 7!P 9 1. <br /> OWNER PHONE: 95096'2`l(QD OWNER EMAIL; ,---•--- <br /> CONTRACTOR NAME: 'G> S1- vl Al e-IR_ <br /> CONTRACTOR ADDRESS: sTRHET " '1-15 N Wee)(__ <br /> - X P L.{ C D co 1 <br /> CnY STATE Y 21P q g b `' <br /> CONTRACTOR PHONE: 1 Le P 2 5 to CONTRACTOR EMAIL: g,vn ITS (�-( Skulpk „,(Ima e-. 6DYVI <br /> CONTRACTOR LICENSE#(REQUIRED): * ST 1� ; 3C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) •�_ 153 <br /> PRIMARY CONTACT: a OWNER 1 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LI a- (.: L ' p m <br /> K' --- CONTACT EMAIL: 9-(7jl�l/)/t,I'�S "`ikiJ-i ik) �fIQ,Q.�� c <br /> . <br /> BUILDING PERMIT APPLICATION 1 <br /> `L Existing We of Building: J Pg. Contract Price of Work:$ 1,1 ) , T, " <br /> 1\ Proposed Use Of Building: e - Heat Source: Gas C]Elactric ClOthar <br /> Building Type: <br /> ,�sFR-Detached ©SFR-Attached ODuplax 1=IMult!-Famlly-#of Units: CiCornmerclol ❑induetdal _ <br /> Type of Project: ONew OAddItlon ORamodel E Repair CIT.►.• ❑Sign LIS prinkler aDemotition OChanrge of Use <br /> DESCRIPTION OF WORK: <br /> , \Pf) D\JC / re,p\A.c,e, 6A-S wov\-e)r \A c ater" <br /> ASSOCIATED Bu iLDINC PERIV1iT#(If appllceble); <br /> MECHANICAL PERMIT APPLICATION , PLUMBING PERMIT APPLICATION �. <br /> 'type of Project: Now_ Addn _Alteration Repair Type of Project: _New _Addn _Alteration _Repair r <br /> Fixtures <br /> Lief of Flxturee Fixtures r Clef ofFixturea Fixtures `' List of Fixtures Fixtures <br /> List of Fixtures <br /> DIC Hendiing Unita iaeet Pum Toilet Backflow _nterQnslde Skip) <br /> torcedAlrSystems Unit Heater Bathtub Urinal• <br /> V Gas Piping Boiler Lavatot (Wash Ha- Drink',• Fountain - <br /> Water Heater Refrigeration Show r Flo* Drain <br /> Gas Fireplace Wood StoveKltah=a Sink&Disposal 0 =see Trap _ <br /> Gas Ranee DT--Dueling Dlshw-sher oof Drains <br /> Clothes Dryer Hookups Other: Clothe: VVasher - ,-djcal Gas V <br /> w Rare Hood Water H. ter 'Or- • <br /> - <br /> Exhaust Fan Sink(Servio= ;ar/Mop/etc. Other: <br /> Smut. a=Slit@p. 'SISiO M .iW <br /> emiaai arwta ,of Heade _ <br /> ACKNOWLEDQEMEN7:1 have reviewed this application end conlfm the information contained herein Is frue end correct Work dope pursuant to this pelmlt mual comply with <br /> current federal,elate,end local law.The granting ole permit only authorises approved work end no deviations therefrom.Gevlaflbne must drat be authorrsed In writing from the <br /> Banding Official berets being authorised under ony circumstance.I em the oWner,ort em authorized by the owner of this properly to perform the work for which epplicalion Is made, <br /> end I comply with 1110 State Contractors Law 1427 RCW and 2se.200A WAG <br /> City of Everett Official Use Only <br /> .rs) I . PERMI # <br /> .A, 3 -7- - i V)/9).-- <br /> _ <br /> ��� <br /> Own-` •uthorze;Ag= Signature Date (Revised 31/20 <br />