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. . 04./28/2017 FRI 9: 06 FAx Feet Witter Heater 121003/004 <br /> °I [ q 3 i <br /> PERMIT APPLICATION <br /> ie.! BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> 1 �. CITY OF EVERETT PERMIT SERVICES <br /> 200 CEDAR STREET,EVERETT,WA 90201 <br /> (P)425-2578&10 I FAX 425-257-8057 1(E)everettepE(geverettwa.gov l www.everettwa.gov/permlie , <br /> Blue or Black Ink Onl se) PROJECTSITEINFORMATION <br /> PROJECT SITE ADDRESS: � 1„� i I V L V I i D1PROPERTY TAX#: ca <br /> I/I V107-7.---4— y <br /> LEGAL for MOW construction: Short Plsysubdlvlsion Lot No, (attach copy of Ione legal desorrptfon) <br /> CONTACT INFORMATIOPI <br /> OWNER NAMEcrnF�W V( TENANT NAME if Commercial}: <br /> OWNER MAILING ADDRESS: eTmi�ET 3 (0 <br /> '/� 1g( J \f J�/(/(i _CV _ <br /> my <br /> OWNER PHONE: c2.01p3'4 ) .:, p Li OWNER EMAIL: -------' <br /> CONTRACTOR NAME: fpi ST UJ i\i k-1"_A-1-- -s <br /> CONTRACTOR ADDRESS: STREET \\%i'{5 1\1 1 VOX— . RI,�l.1 $ {�I D(i <br /> CRn <br /> Y Z V t- -`d(_.- STATE 1k/A.. ,�,.' YIP `9 1� 0\\ . <br /> CONTRACTOR PHONE: (-la 5 tO t' `In'1 CONTRACTOR EMAIL:fi f em\T S Fu u•)0�1W\Mc1 'r. (,OYli <br /> CONTRACTOR LICENSE#(13EQUIRED);f 4 5T 1/,) r, i j CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 17, CONTRACTOR D OTHER(Please Specify) _ <br /> CONTACT NAME: �'5, I CONTACT PHONE: L. 3 <br /> Kf'r - CONTACT EMAIL m It C�-�� 1 1. <br /> BUILDING PERMIT APPLICATION <br /> Existln, Use of Bulldin,: • i l Contract Price of Work:$ 1 .. ii, <br /> Proposed Use of Building: E1/ljf Heat Source: E1Ges lr= lactrlc DOther 4.- <br /> Building <br /> Building Type: ❑SFR Detached DSFR-Attached DDuplex c MultI.-Family-#of Unita: 4 DComrnerclal Dlndustrlal <br /> •e of Pro ect: ❑New ICIAdditron DRamodel IA Re.:it DTA. OSI.n ❑S•rinkler LIDemoittion DChange of Use <br /> DESCRIPTION OF WORK <br /> irn 0 / r2,�\ C '. dem Cw, Ott Vk CCc,-��r <br /> ASSOCIATED BUILDING PERMIT#fif epplicehie): I V l lel' I tS / ► D <br /> • <br /> MOCHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION ' <br /> Type of Project; _New_ Arkin LAIleretlon Repair Type of project: New _Addn _Alteration _„-Repair <br /> !i of Lfst of F/xtu °f List Fixture? ofList of Fixture? of List of Fixtures <br /> flxtu .- Flxfures Fixtures Fixtures <br /> AIC-Air Handling Units_ _ HPump Toilet ,Backflow Preventer(Inside Bldg) <br /> Forced Air Systems • nit HeaterBathtub Urinal <br /> Gas Piping Boiler Lavatory Main Basin) DrinkIri Fountain <br /> Water Heater j-QM.oration' Shower Floor Drain <br /> . Gas Fireplace ,'ad Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range • - DuoDishwasher . Roof Drains <br /> Clothes Dryer . ups Other. _ Clothes . Medical G. <br /> 'r: . a er Heater�� Other. <br /> Exhaust Fan Sink•(ServtcearIMop/etc.). Other: <br /> SPAIN AE5$IOAWSTMM _ <br /> emloat or�fem " talo.of Heade <br /> ACKNOWLEDOE141:N7:t he reviewed fhie application end confirm the lnfon»allon contained herein Is true end correct Work done pursuant to this permit must comply with <br /> cumuli federal,state,and local law.The granting of e permit only authorizes approved word end no deviations therefrom.Deviations must first be authorized In writing nom the <br /> Bulfding Officlal haters being authorized under any circumstance.I am the owner,orf am authorized by(he owner of this pmparty to perform the work lorwhich appIfoaik n is made. <br /> end I comply with the Stale Contractors Law 18.27 ROW and 296.200A WAC. <br /> Q" City of Everett OHlora!Use OMy <br /> ( -7OLI--0& ---j <br /> Own,' .uthorze.A9 Signature este (Revised201 <br />