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06/19/2017 MON 14: 58 FAX Fast Water Heater 2003/005 <br /> =.=--.,=----..........------- -.,_... _-•- -- .. w... .- . <br /> A q b 1-9 <br /> OilErrPERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING i SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 2200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257.8810 I FAX 420-257-8857 I(5)everettepseeverellwe.gov I www.ewsretlwa_gov/permIls <br /> Blurs or Klock Ink Oni Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: • 1 / i 1 41 j „,,(� PROPERTY TAX#: 00 5 I . I • (I b V <br /> LEGAL For new construction: Short Flat/subdivisionLot No. (attach copy of long lege!detail:Mon) <br /> CONTACT INFORMATION <br /> OWNER NAME: KO0 11 0 ' TENANT NAME(If Commercial); -- <br /> OWNER MAILING ADDRESS: miser ' al 6� 1 r 116 . % A /y��� <br /> • <br /> an, , f.• r * , STATE / 1 _ TIP g4� 63 <br /> OWNER PHONE; (-1. 5 54 35' 0 OWNER EMAIL: •----- <br /> • • <br /> CONTRACTOR NAME; fps Sl- fti Ai e. ...vs... --A.-1-'Fie - �` <br /> CONTRACTOR ADDRESS: STREET �1'�1 4 1 EA ° A. $ it r 1 1)(p <br /> yn�- Val �[n n 1 <br /> CITY ti V -lr� STATe () d 1 21P 1 1] V `\._.._ <br /> CONTRACTOR PHONE: "E'2S i gr • CONTRACTOR EMAiL: IF em vi- 1.4 -\--wt . A//-c4-, D <br /> CONTRACTOR LICENSE#(REQUIRED): I Sl- kir 1 $C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) •453 <br /> PRIMARY CONTACT: U OWNER tM CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LIP'S'. .3 L I V <br /> \(A ' -�r�"U� CONTACT EMAIL: (,�Q,r(l�/a,-d <br /> � A .-sir, (A3V(/I <br /> BUILDING PERMIT APPLICATION <br /> 1,4 Existing Use of Building: 5Contract Price of Work:$ ___ <br /> Proposed Use of Building: �� Heed Source: l leas lactric UOther <br /> Building Type:CFR Detached DSFR-Attached ODupiex ❑iVfuitt-Family-#of Units;__ ElCommerciel I:Industrial <br /> Type of Project: ONew OAddition I:Remodel 'CISIRepeir OT.I. ©sign OSprinkler ❑Demolition CiChenge of Use <br /> DESCRIPTION OF WORK: <br /> VY1046 / (e \G�c,i° .ei-r__G'rr1'C:- w oc.\-' V\E Gtr" . <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL,PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typeof Project: _tow_ Addn _Alteration _Repair Typo of Prefect: _few <br /> _Addn _Alteration <br /> iloftSTF/xtures of II of #of <br /> Fixtures t Ixturas Liet of Ff urea Fixtures <br /> of Fixtures Fixtures Gist of Fixtures <br /> a-Air Handling Units Heat Ru <br /> Toilet. Backflow Preventer(!Held®Bldg) <br /> e...... 742/8 <br /> Forced Air Systems Unitafar Bathtub Urinal <br /> 1` Gas Pieing =�i!! Lavatory(Wash Basin) Drinking Fountain - _ <br /> Water Heater Igeratlon Shower Floor Drain <br /> Gas Fireplace WO.. Stove -- KTt'hen Sink&Disposal Grease Trap <br /> Gas Ran!e - " bucti . ' Dishwasher Roof Drains _ <br /> Clothes Dryer Hookups Other: Clothes Washer. Medical Gas <br /> -1,e Hood MO Water Heater _ Other; <br /> Exhau• -- Sink(Service/Bar/Mop/etc.) Other: <br /> -- <br /> SPRIwJ. i-sUPAE$SIOI sTE r <br /> . ntical or W .of Heads _ <br /> ACV 1OWL@DGEMErmT.I have reviewed this eppiicafion end confirm the Information contained herein Is true and cored.Work done pursuant to this permit moat comply with <br /> current fedarel,slate;and local law.The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authotlEed hf writing from the <br /> Building Official befole tieing aulhorked under any droumelance.f am the owner,or l am authorized by The owner of Ude property to perform the wont for which application le made, <br /> and I comply with the State Contractors&ew f8.27 ROW and 29t200A WAG. <br /> City of EverJetttO�Official Use only <br /> /� , ),1 , u,.... ( t� r 1 [ HRM!T#m <br /> ii o o& <br /> own: other zo Ag= Signature pale (Revised n/zsrzorej <br />