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Aug 08 2018 03:53PM Washington Wa -Heaters 8663757454grr pages <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING 1 SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 )(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) ��// PROJECT SITE INFORMATION �f/ �s�,/ <br /> PROJECT SITE ADDRESS: )71 —1 ccea cL.( 5 PROPERTY TAX#: 4.90424,11/60 60‘7UU U <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �`' �n /� 1 CONTACT INFORMATION <br /> OWNER NAME:\JON tic, !1 l l'!v Lk� /j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> j/j�'1�11 ! to.+�av"�3 �.J(� <br /> CITY l.t''it.6 . ;l STATE A. zip ! ✓2.0-f <br /> OWNER PHONE: 14$t) `+ ,�t((I //me q OWNER <br /> EMAIL:may . . .. . <br /> CONTRACTOR NAME: 1/V ftSi`[E AiO1 t V J 14-T Jam ! J /�� �Ux p U <br /> CONTRACTOR ADDRESS: STREET I'7I S Z i 1Lill- 4- L r S,/y/ k �j <br /> ,,// / Ccrrr' p/(�fi ar i STATE of / 21P ggrV � <br /> CONTRACTOR PHONE: T 2 J"U i 3 Yb l I[�Q�,(�p CONTRACTOR EMAIL: '�,(f VAC U/IYI IL. LU_YY �� ; <br /> CONTRACTOR LICENSE#(REQUIRED):jr{I " 7C�u[J� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 66" 3�` -4 <br /> PRIMARY CONTACT: 0 OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME-/Kt <br /> PHONE: 419.- --g3 -Lig 7/,�n.Cc,L / <br /> V I D l t! !r 5 CONTACT EMAIL: W /1 /C <br /> ifit- Q 6'rW 1 ,,toy/ <br /> i <br /> ! � ,BUILDING PERMIT APPLICATION <br /> � w'^, <br /> Existing Use of Building: ` a.-1fContract Price of Work:$ , °':r0 .. _ <br /> Proposed Use offB`uiillding: Heat Source: ❑Gas fectric DOther <br /> Building Type: R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial O)ndustrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. Osign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIP ON OF WORK: <br /> 4 6ifYibe 1Ae. Ci-le,MIL. / Eit(j C/17,C: 604416/446/-(Y(S) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION � <br /> ,,p f_�I <br /> Type of Project: _Now Addn Alteration _._Repair Type of Project: New _Addn Alteration _Rep r ��W/ , <br /> #of #of List of Fixtur <br /> List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures <br /> Fixtures Fixtures Fixtures <br /> NC--Air Handling Units Heat Pump Toilet Backflow Preventer(Inside BIdg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinkin1Fountain. <br /> Water Heater Refri eration ShowerFloor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: C'othes Washer Medical Gas <br /> _ Range Hood 1 Water Heater Other. <br /> • <br /> Exhaust Fan Sink(ServicelBar/Mop/eIC.) Other: <br /> • SPRINKLER 1 SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.:I 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 taw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and i comply with the State Contractors Law 18.27 RCW and 226.200A WAC. . <br /> City of Everett Official Use Only <br /> t. �"/ 1gPERM17 i � �l r I/)� , (52.,k_c <br /> Qjq„,„(_., <br /> Date (Revised 0/2016) <br /> OAuthorizedAgentSlgnature <br />