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Feb 24 2017 01:45PM Washington Water Heaters 8663757454 page 5 <br /> PERMIT APPLICATION <br /> BUILDING (MECHANICAL I PLUMBING/SIGN /SPRINKLER 1 DEMOLITION <br /> #11114:=A <br /> CITY OF EVERETT PERMIT SERVICES <br /> `� 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black ink Only Piease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 53 5 edr YeA aog !PROPERTY TAX#: 06 E4 9 33 5zo girt <br /> LEGAL for new construct`.on: Short Plat/subdivision Lot No. <br /> (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (4,)/(J ) G/ becK. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 33 5 , ,ecci- l v 4120E, / <br /> CITY 41 STATE WA ZIP q O(�413 <br /> OWNER PHONE: 6 1-0(o(o() !OWNER EMAIL: <br /> • <br /> CONTRACTOR NAME: W/1-501 A)6177/6-) iii---j- L HCA-7-6--(4_5: <br /> CONTRACTOR ADDRESS: STREET Illy Z j((, - kr c1 ..- FO i OX 9�S <br /> CITY pent-Oil STATE (AA- ZIP q U 5e <br /> CONTRACTOR PHONE: 426 4g3— L/f 7 f "CONTRACTOR EMAIL: ( H.,U/9-j y (06 liV9 IL CM <br /> CONTRACTOR LICENSE#(REQUIRED): Wil/fairckVi 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05 gAl-e <br /> PRIMARY CONTACT: E]OWNER E .CONTRACTOR El OTHER(Please Specify) <br /> CONTACT "7/ <br /> NAME;.„ CONTACT PHONE: (/2 -g 9-c/s7 <br /> J I l(-(IS CONTACTI <br /> EMAIL: L{��jf/�',KG,�{.�6irbif1L,LUQ`/ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building; Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: OGas tOectr1c ❑Other _ _ <br /> BuildingType: 1DSFR-Detached y :Cornmerclal Olndu a <br /> �R-Attached ❑Duplex ClMulti-Family-#of Units: <br /> Type of Project :New DAddidon ❑Remodel ❑Repair CIT.!. OSign ❑Sprinkler ❑Demolition ❑Change of U e <br /> DESCRIPTION OF WORK: <br /> VOKION1 e-`4" LO-P(Cta I Nechlt) bucanc itict.kr <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION ~ <br /> Type of Project: New Addn Alteration _Repair Type of Project: wNew _Arkin Alteration Repair <br /> #of #of #of <br /> Fixtures List of Fixtures List of Fixtures List of Fixtures Fixtures <br /> of <br /> Fixtures Fixtures fixtures List of Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain - <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range <br /> 9 Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mopietc.) Other: <br /> t <br /> • SPRINKLER/SUPPRESSION SYSTEM <br /> 'Number of Heads <br /> ACKNOWLEDGEMENT:t have reviewed this application and confirm the information 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 work and no deviations therefrom.Deviations must first be authorized in wiling from the <br /> Building Official before being authorized under any circumstance.I an,the owner,or I an,authorized by the owner of this property to perform the work for which application is made, <br /> en ply with the State Contractors 1. w 18.27 ROW nd 296.2004 WAC. <br /> ( /j , City of Everett Official Use Only <br /> C)4/-17 1 privy <br /> Owner/Authorized Agent Signature Date <br /> (Revised SJ2U/20i ) <br />