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10/05/2017 THU 12: 05 FAX Fast water Heater 421003/004 <br /> II <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OP EVERETT PERMIT SERVICES <br /> 11..H.,"`: 44-1,1- <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-0057 I(E)averettepa(g)everapwe_gov j www.everettwa.gov/permlte <br /> 1131uo or 13Iack lank Onl. Pi®alai® PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -qtyqY `T 7 PROPERTY TAX#: ► /05 <br /> e 0 O D's 0_ , y <br /> LEGAL for new construction: Short Plat/eubdIvIslon r - lot No` (attach copy of long legal descriplion) <br /> CONTACT INFORMATION <br /> OWNER NAME: k 1 A Al TENANT NAME(II Commerele1): <br /> OWNER MAILING ADDRESS: STREW' 331) Ho LIT. ' UG- _ <br /> °ir STATE ( J4 zlr. 8o 1 <br /> • <br /> OWNER PHONE: ..ri i 1 [41 OWNER EMAIL: ." 1111 <br /> CONTRACTOR NAME: ?ASI AAI Al �,, we-A.--r-E-/g., <br /> . ._ <br /> CONTRACTOR ADDRESS: STREET nom`\ -1 l N €Q- p .W'-1 S .: C Dc)l y/,�t'r�! 1 <br /> � om' k J O 1 �I,.. STATE ZIP `1 Y I J <br /> CONTRACTOR PHONE: L- 5 S to lt "CONTRACTOR EMAIL:pv Q.m n-S -R15-\-u Skoda ', (AVli <br /> CONTRACTOR LICENSE#(REQUIRED):fas"(^wvo0G19g 136.„ [CITY OF EVERETT BUSINESS LICENSE 91(REQUIRE0)5453 <br /> PRIMARY CONTACT: 0 OWNER j CONTRACTOR 0 OTHER(Please Specify) , <br /> CONTACT NAME: u �/ /� v CONTACT PHONE: LA 05 , r a. a <br /> lir`' 1�Y� I � . CONTACT EIVIAIL: :I i ��' � .,.t?,,,, w/ it <br /> BUILDING PERMIT APPLICATION r <br /> Exrsting Use of Building: 5 ..-' Contract Price of Work:$, . 1509. y <br /> Proposed Use of Building: S I'P jHest Source: leirOas DElectrlc ❑Other <br /> Building Type: OFR-Detached ❑SFR-Attached ©Duplex ❑MuIU-Family-0 of Units: IJCommerelel Olndustrlal <br /> Type of Project: ONew ©Addition ❑Remodel kfRepeir DTI.' D5ign ❑Sprinkler ❑Demolltion JChange of Use <br /> DESCRIPTION OF WORK: <br /> fklY\ 0\i / v'e,10Ace. 61\-S IA)oLA-elr 1Ac ateAt— <br /> ASSOCIATED EUII.15(NG PERMIT#(if applicable): _ <br /> MECHANICAL PERMIT APPLICATION _ PLUIUMB1NG PERMIiT APPLICATION <br /> Type of Project; _New_ Addn _Alteration _Repair Type of Project: New _4ddn _Alteration Repair , <br /> • <br /> #of List of Fixtures #°f List of Fixtures #of Li. ru :T_ #of List of urea <br /> Fixtures F/xturea _Fixtures . urea <br /> AIC,—Air HandllnaUnits Heat Pump Toll Backflow P -, ,,nter(Inside Bldg) <br /> Forced Alr Systems Unit Heater _ Fla tub rinel <br /> ` " IIGas Piping 'Boller La,-to Wash Basin Dr ..1 .c ountain <br /> f J Water'Heater - Refr gergtIon S • er Flo. . =in <br /> V Gas Fire lace - - Wood Stove Kltphen Sink&Dloposal +- Setae _• <br /> .." <br /> Gas Range Ducting DI= washer f Roof Drain, _ <br /> Clothes Dryer Hookups Other: Clo es Washer / Medical Gas i <br /> Range Hood iNa, Heater / Other: . <br /> Exhaust Fan Sink •ervIce/Bar/Mop/e • Other: <br /> SPAIN ER-f..SU f$SS1O�l _SY-STEM �~ <br /> Iordeal or W -"------1.14A.of Heads <br /> ACKNOWLEDGE/V:4NT::I Neve reviewed this application end confirm the infer-netion contained herein Is true and correct.Work done pursuant to this permit must comply with <br /> current federal,stela,and local law.The granting ole permit only authorizes approved work end no deviations thorefrem.Daviefohs must first be authorized In writing horn the <br /> Building Offl dal befolla being authorized cinder any circumstance.I am the owner,or/am authorized by the owner of ihia property to perform the work for which epplioatlon Ia made, <br /> end 1 comply with the State Contractors Law 18.27 ROW end 288:200A WAG. <br /> City of Everett <br /> EverettOfficial Use Only <br /> YPERMIT# flln, 6l <br /> (6 <br /> grtt � y`! 10,-5, 1-3- <br /> . <br /> Own uthorzASignature Data (Revised8/251Q1 ) <br />