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09/18/2017 MON 15: 44 FAX Fant water Heater 1j007/009 <br /> US <br /> PERMIT APPLICATION <br /> I <br /> � BUILDING/MECHANICAL/PLUMBING/SIGN!SPRINKLER/DEMOLITION <br /> ' ` w 1 rc CITY OF EVERETT PERMIT SERVICES <br /> •, 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)evereltepeeevarattwa.gov I www.evereitwa.gov/perm!ts <br /> Blue or Black Ink OM Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: AI A AI ' .. . . ST PROPERTY TAX*: ,Ir d'OA Lip • 4F <br /> LEGAL for new construction: Short Plel/subdlvlslon Lot No`-_ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: VUKI-ire.3K J, i/J TENANT NAME(If Commercial): •-- <br /> OWNER MAILING ADDRESS: emu 5 I gEL G 1/g 1,E,.. ,Sr <br /> .. G 1'590 <br /> onY STATE 1/V LL 21P <br /> OWNER PHONE: (Qo3, 1O5 OWNER EMAIL: <br /> CONTRACTOR NAME; fA ST ink Ai g 14'e-AT /Is <br /> CONTRACTOR ADDRESS: STREET l I N We p_ i?Y_LkN.1 S C n co <br /> cm Z 0 t.,-L- arms I Lfh zIP 1 o�A <br /> CONTRACTOR PHONE: _lO S 117 �� D v l `CONTRACTOR EMAIL: F Z Vy1 ITS 1 11 . <br /> A-1 , A `Im/Lr,, 1 <br /> CONTRACTOR LICENSE#(REQUIRED):� S1-1A�)\-t'oiU sc CITY OF EVERETT 13116/NESSL LICENSE tk(REOUIRED) 01153 <br /> PRIMARY CONTACT: DOWNER CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: /� V ` �,1 CONTACT PHONE_ C f a,5' , ' lir <br /> Ki-� i��t �)� CONTACT EMAIL: t/t:WS e - �Crl lea �l� . .PX'. WO <br /> BUILDING PERMIT APPLICATION <br /> Existlng_Use of Building: 5 Contract Price of Work:$ _ NI g 9r <br /> proposed Use of Building; Heat Source: ,IGas °Electric IJOther 4. <br /> Building Type: *FR-Detached ©SFR-Attached ODuplex OMultiFamlly-#of Unite: UCommerclal CI Industrial <br /> Type of Project ©New ©Addltion ❑Remodel Repair ©T t.' OSign OSprinkler ODemolitlon OChange of Use A <br /> DESCRIPTION OF WORK: <br /> fk(YI 0\/6 l reQ\A e G,eirS w oL-\6r 1A c afi <br /> ' ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATMON <br /> Type of Project; __ New_ Addn _Alteration _Repair Type of Project: _New -_4ddn ,_ Aiteratlan _Repair <br /> fixtures • <br /> List of Fixtures F to @a List of Pixtures Fixtures List r : #urFes List of P/xtur9s <br /> A/C-AlrHandlingUnita Heat Pump Toilet Backflow PreventerSInsid= cldg) <br /> Forced Alr Systeme Unit Heater Bat rinal <br /> Gas PI In .Boller Lav:tory(Wash Basin)__ Dr .Ing Fountain <br /> Water Heater Refrigeration _ Sho er Floor' ,in <br /> Gas Fireplace Wood Stove Kitc ;n Sink&Disposal Grease ''- — <br /> Gas Range Ductln9 Dish asher Roof Dral ` .. <br /> Clothes Dryer Hookups Other: Clothe- Washer. Medic= - <br /> Range Hood •_ Water ter 01h. <br /> Exhaust Fan Sink Mery••= Bar/Mop/etc.) •• er. <br /> _ S +RIM ESSlOt SYSTaM — • <br /> P enlIcal or — ,of Heads '_-.— <br /> •ACiWOWLEWEls91eN7"I have reviewed this application and confirm the Information contained herein is true and comics;Work done pursuant to this permit must compry with <br /> current federal state,end local law.The granting de permit only authorizes approved work and no deviations thereaam.Devletlons must fast be eufhorlxed In writing from the <br /> Building Official berate being aulhOd1ed ander any cbcumslence,I am the owner,or/em authorized by the owner of fide property to perform the work for which appliication is made, <br /> end I comply with the Stele Contractors Lew 1&27 RCW and 296.200A WAG. <br /> City of Everett Official Use Only_ <br /> ,_., 1 ,.-.‘ i , . 1 PERMIT*1/ /+ 12cY9—OL(1 <br /> Own .uthorse; Ag: Signature rIto_ (?evlsedOL21lafr4b) ' <br /> , <br />