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10/05/2017 THU 12: 06 FAX Feat water Heater 0004/004 <br /> D15 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL / PLUMBING /SIGN /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 I(H)everetteps@everellwe.gov� www.evorettwe_gov/permIts <br /> (Blue or Black Ink Only Please) PROJECT SITE_INFORMATION <br /> PROJECT SITE ADDRESS: c g 3 W COMB y r I . PROPERTY TAX#: O 13q i( D R-6g.mi y <br /> LEGAL for new construction: Short Plat/subdivision•�__ .. Lot No. (attach copy of Ions legal deecripllon) <br /> CONTACT INFORMATION <br /> OWNER NAME: bi f L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTIikEl g.g3 L (Az y Ave <br /> orrr gjiSTATE J* ZIP q K.901 <br /> OWNER PHONE: p I OWNER EIVIAIL: <br /> CONTRACTOR NAME: A ST 1. A ., :. a <br /> CONTRACTOR ADDRESS: 3TREEr `T'•" 15 N _I,LY f.) PLA) S _C—v_D( „ <br /> cnY Z V ' U/ . . 8TAT1k ZIP .O S-0 I <br /> 1 <br /> CONTRACTOR PHONE: (l 04 s k)-6 .,-6 ., CONTRACTOR EMAIL:P Z on 11 S q.S� I Dale tr 1V1.k) • VAil <br /> CONTRACTOR LICENSE;#(REQUIRED):fSfi"wyu\--L J R Sc jCITr'OF EVERETT BUSINEss LICENSE#(REQUIRED)50(-45 <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR D OTHER(Please Specify)_�„_� <br /> CONTACT NAME: /� �/ CONTACT PHONE: ,/�.{ ek '3 -9� I ' <br /> K�� [H -L______,.- eCONTACT EMAIL: p_/l VIe,ISa1�1/LR� - '/ G5V11 <br /> BUILDING PERMIT APPLICATION - <br /> ExIsting Use of Bulldinro: ' Y�Vf-nh_ Contract Price of Work:$ I _ ,_, <br /> Proposed Use of Building: h V Heat Source: Ass ❑ElectrIc DOther -.... <br /> BulidinA Typo: OSFR-Detached ❑SFR-Attactlad ©Duplex ulf-Family-#of Units: ©Commetclal ❑Industrial <br /> Type of protect ❑New De dditlon DRemodel (:IRepalr DTI_ DSIgn DSprinkrer ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: n 5 <br /> V\() D\JC, / re,Q\ot.ce rvl INAPr�'c;al a� c Gl,� <br /> co <br /> ASSOCIATED HUILD$NG PERMIT#(If apjoHcabLe.): _ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _flew_ Addn _Alteration _Repair Type of Project; _Naw Addn _Alteration _RopnIr <br /> fi of of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Flxto es 1-r= • , ores F/ uY@g` List of•)(fume <br /> A/C W Air Handling Units Haat Pump To-z Backflow Pro star inside Bid <br /> Forced Air Systems 'Unit Heater a l thtub Urinal <br /> —Gas Piping Boller avatory(Wash Bash 'DrinkIng r.untain <br /> Water Heater Refrigeration .hower F.. • in <br /> Gas Fireplace Wood Stove • <br /> p Kitchen Sink Disposal Ore- e' <br /> Gas R_ange__ Ducting Dishwasher -•-of Drains <br /> Clalhee Dryer Hookups Other: lothes Washer odlcal Gas <br /> Range Hood T Ater Hester - Other: <br /> Exhaust Fan S k(Service/Bar/Mop/etc.) Other: <br /> SP�tIN •BR-/-$ I�SSIIp�SIFsT!M <br /> Icemlcal or V his,of Heads <br /> . <br /> ACKNOWLEDGEMkNT.-/have reviewed this application and confirm the Information contained heroin Is true sad correct, Work done pursuant to this permit must comply with <br /> current federal.state,and focal law.The granting of a permit only authorizes approved work and no deviations therefrtrrn.Deviations must first he authorized in writing from the <br /> Buffding Official before being authorized under any circumstance.I em the owner, orI em authorized by the owner of lits property to perform the work for which application Is made, <br /> and 1 comply with(he State Contractors Lew 16.27 RCW and zae•200A WAC. <br /> yCity or _vere(t Official tree Only <br /> r 441 <br /> 0wnr •uthorzAt.Signature Date (Revised 0/23/2015) <br />