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09/18/2017 MON 15: 44 FAX Fast water Heater fd1009/009 <br /> ibs- tirqs.) <br /> - PERMIT APPLICATION <br /> BUILDING /MECHANICAL I PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OMbstrai- - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8870 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.evereltwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I'312, 1-f A)I T AVE PROPERTY TAX#:00(43e/I be 140330D ' <br /> LEGAL for new construction: Short Plet/eubdivIaion Lot No. (attach copy of long legal desoriplron) <br /> CONTACT INFORMATION _V _ <br /> OWNER NAME: [•�Al�-1 DU� TENANT NAME(If Commercial): G f 7 J -Ma pm Res{-. <br /> OWNER MAILING ADDRESS: smear 4W1-014, <br /> CRY el .J army IA/m- BP 1 $atJ <br /> • <br /> OWNER PHONE: rpimpwritimiiiiin OWNER EMAIL: <br /> CONTRACTOR NAME; fs ST IAAliMp sgoF/S <br /> CONTRACTOR ADDRESS: !STREET 1 1'j N p,w,...{ <br /> S ,_______ca.„4,_________ <br /> .. CRY so fu� <br /> awe uA_Rs,„.),,„,,,wa_sie,r.ZIP CI �D 11 <br /> CONTRACTOR PHONE: d S t 1/ S CONTRACTOR EMAIL: 'g v..VY1 fl tOVj <br /> Pl��y- <br /> CONTRACTOR LICENSE#(REQUIRED): S1 )\ 0 Q$ L1, CITY OF EVERETT BUSINESS LICENSE II(REQUtRED) } 5 <br /> PRIMARY CONTACT: I:1 OWNER ( CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LIPS- u ,�� ���`L�� CONTACT EMAIL: il' <br /> ` P�rits.�-� . / j <br /> BUILDING PERMIT APPLICATION _ <br /> `! Existing Use of Building: fowirj t6v-G4� Contract Price of Work:$ •Yi D - <br /> 'T" Proposed hoe of I9ulldituQ: CS51/I,4 jl^G TA- Heat Source: , as I:Eleciric DOther _ _ <br /> Building Type; DSFR-Detached CISFR-Attached DDuplex LJMuitl-Family-#of Units: G°ommercial IJIndustrlal <br /> Tempe of Project: DNew DAddition DRemodel IRopair EIT.I. Si <br /> ❑ gn OSprinkler DDemllti <br /> oon ©Change of Use <br /> DESCRIPTION OF WORK: <br /> AA <br /> f,tvyA o\ l r2 \A.C,e, yS CM n -CI- lA)ar\- \ C Oc - <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New —Addn _Alteration _Repair <br /> #of Lief of Fixtures #°f List of Fixtures #°f List of fixtures #of List of Attu•s <br /> Fixtures Fixtures Fixtures Mures <br /> A/C-Air Handling Units- Heat Pump Toilet Backflow Previa .__guide Bldg) <br /> Forced Air Systemsc) Unit Floater Bathtub Urinal <br /> bas Piping Boiler Lavato Wash Basin Inkine •untaln <br /> Water Heater Refrigeration - Shower Flo'Train _ <br /> Gee Fireplace Wood Stove Kitchen Sink&Disposal =a=• Trap <br /> Gee Range Ducting Dishwasher Roof Dr. e <br /> Clotho&Dryer Hookups Other: Clothes Washer - Medical 0- <br /> Range Hood Water Heater Other: <br /> Exhaust Fan -- - --- - ink(Service/gar/Mop/. . Other: <br /> SPRED% ESSIO IVI <br /> t enticgl or W <br /> .of Heeds v <br /> ACKNOWLEbGEMtyN7'.I have nsvlawed this application and confirm the Information contained herein Is true end coned:Work done pursuant to this pernitMud compry with <br /> current federal,slater end local law,The grant/ng of a permit only authorizes approved work and no deviations therefrom,nevlaffons must Ms!be authorized In writing from the <br /> Building Oyfdel before being authorized under any circumstance.I em the owner,or!am aultrorfzed by the owner of this property to perform the work for which eppficallon is mads. <br /> end t comply with the State Conlreoton9 Law18.27 BCW end 296.200A WAG. <br /> Ctly of Everett Oftt/UaaI Lisa <br /> Only <br /> PER <br /> to / ✓ 1111/\` og <br /> Own uthor ge Ag signature Date (Revised 9/23/2016) <br />