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07/19/2017 WED $: 23 FAX Fast Water Heater 0005/005 <br /> s...«• _ _ �.. _ _— ---------- ........-.rte <br /> 1 g 21)el <br /> � PERMIT APPLICATION <br /> � ,i • BUILDING/MECHANICAL I PLUMBING/SIGN 1 SPRINKLER!DEMOLITION <br /> f_ CITY OF EVERETT PERMi SERVICES <br /> v - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)426-257.8810 I FAX 425.267.8867 I(E)everetteps(ireverellwa.gov I www,everettws.gov/permIts , <br /> (Biu®or Block Ink Only Please) PROJECT BITE INFORMATION <br /> PROJECT SITE ADDRE55: I'1. 0 (/) Ca,SV,o et) II'.'13 PROPERTY TAX#: b 0- U <br /> LEGAL for new construction: short PIM/subdivision _ _ Lot No, _ (attach copy of long legal description) <br /> CONTACT INFORMATION _ _ <br /> OWNAMENER : ISA-- WI f i ,( l rV Y 4 ,S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: erReer 144 50 (.A) C/I 5.f IQ 0 e D _ix._ <br /> "1.3 <br /> ���� enyv� /� V STATE' zm el gaz5 J <br /> OWNER PHONE: 5 v`_5t) `�L ! I OWNER EMAIL: <br /> CONTRACTOR NAME: fS 1 II.I `� 1� ' i- <br /> CONTRACTOR ADDRESS: sTResT '11-15 Y e f)y ,f $ 1 C 11)(e <br /> _ etre Z"-11--1 4 L_ STATE, LAA rP q igD1 I <br /> CONTRACTOR PHONE: "1 <br /> 2 5 io3lg CONTRACTOR EMAIL:F iz irn as 0-c-ASi'u) wm_c-e4 . CjtiVIi <br /> CONTRACTOR LICENSE#(REQUIRED):�A-5' 1J q"i i <br /> j✓ .CITY OF EVERETT DUSINEee LICENSEtt(REQUIRCD)5 953 <br /> PRIMARY CONTACT: 0 OWNER (l CONTRACTOR 0 OTHER(Please Specify).. _ _ <br /> CONTACT NAME: �^ CONTACT PHONE: ''Tp-5-r ' Le IDS-1-1 <br /> Km41 ir' 1-,- - CONTACT EMAIL: P r Wat5 r , ;(Sl wUi 4-/, Gav <br /> BUILOINO PBRMlT APPLICATION 1 L <br /> Existing Use of Building: <br /> Contract Price of Work:$ "t - <br /> Proposed Use of Building; Aft ' Heat Source:ORtles 0Electric Mother <br /> Building Type: ❑SFR-Detached . ❑SFR Atteched ❑Duplex O Multi-Family#of Units: EICommerclel ❑industrial <br /> Type of Project: DNew ❑Addition Remodel agiRepalr DT-I. OSign ©Sprinkler ❑Demolition ❑Cha nge of Use <br /> 17ESCRIPT1QN OF WORK: <br /> fe,VV) G -S wo* 1f\ cater- <br /> ASSOCIATED BUILDING PERMIT ft(if applicable): ._, <br /> MECHANICAL PERMIT APPLICATION _ PLUMBING PERMIT APPLICATION <br /> Type of Project: _Naw — Addn _ AIieration Repair W Type of Project _New _Addn ,_Alteration Repair , <br /> FixturesList'of Flxturea Ffx#ta as List of Fixtum es Llst of Fl re #Qf List of Ft ,s <br /> Fl urns Flxtwes <br /> _,AIC-•Air Handling Unite Heat Pump Toilet Backflow Preve• =((Onside Bldg) <br /> Forced Air Systems Unit Heater :Bathtub -Urinal <br /> 0 Gee Piping _ Boiler Lavatory_(Wash Basin) Drinkin• -•untain <br /> Water Heater Refrigeration Shower Floor . sin ... <br /> Gas Fireplace Wood StoveKitchen Sink&Disposal a'.:se Trap <br /> Gas Range Ducting _ Dishwasher Aof Drains <br /> Hood <br /> 'keno• <br /> Dryer Hookups Other' - _- _ Me•cal Gas i <br /> ge _ = Othe <br /> Exhaust FanT (Service/Har/Mop/s l••, Other: <br /> ammo_ E4SSIO14..S ST»M _ <br /> It�(iemlcai or_ ®ter— No.of Heads <br /> ACICNOWLEDGEME(VT-I have reviewed this application and confirm the information contained herein Is true end correct.Work done pursuant to this permit must comply with <br /> current federal,state(end local taw.The graniing Os permit only authorizes approved work and no deviaflons therefrom_Devlatlons must first be authorized In writing from the <br /> SuiWIng Official before being authorized under any circumstance.I am the owner,or I em authorized by the owner of this property to perform the work forwhleh application is made, <br /> and I comply with the State Contractors Law 13.27 ROW and 203.200AWAC. <br /> / <br /> CRY of Everett Of/icia/Lies Only • <br /> SII•, / A. '/V I-- ( (�Q'r ( PERMIT 10�'-. O <br /> • <br /> Own' •uthor le- Ag• Signature Date (Revised 9/23/201d <br /> i <br />