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06/01/2017 THU 16: 25 FAX Feet Water Heater i0004/006 <br /> 01 1 i 01 k.4 <br /> • PERMIT APPLICATION <br /> ,,-1111 . BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-257-9810 I FAX 425-2574857 I(E)evaretteps®averetlwo_gov I w wv.everetlwa.gov/permits <br /> (Blue or Black Ink OnlyPlease) PROJECT SITE INFORMATION _ _ <br /> PROJECT SITE ADDRESS: pL5 10 laV c,�.E le j 4+ (, PROPERTY TAX#: OD LO 3L5 o (0 0b j <br /> LEGAL for new construction: Short PlaVsubdivi?lon Lot No. (attach copy of Iang legal desoription) <br /> CONTACT INFORMATION <br /> OWNER NAME: V r A-LA, TENANT NAME(If Commercial): ..---- — <br /> OWNER MAILING ADDRESS: sTREEr v/Q` 510�}�.12 U L/K./e )E 44'l {/.��— �j, �,Q� <br /> o y e eA -641 ?TATE �/! 7JP I.5(I.� `� 1 <br /> OWNER PHONE: CI(J 9 g. NI ' 2-a. !OWNER EMAIL: ..—^- rV <br /> CONTRACTOR NAME; IA,ST" i r _' • T <br /> CONTRACTOR ADDRESS: 6TREET la �l Q( L TyA,,Y-{ S C Z11)�V(/p 1 <br /> any 0 " 1.,..1.-." 1.,..1.-." ,. STATe I J � ^111263 11,, 1 5./� 1 <br /> CONTRACTOR PHONE: �a 5 (Q' j O V l !CONTRACTOR EIWAIL: Afiran , (ice•V <br /> CONTRACTOR LICENSE#(REQUIRED):%S� W wi'�'c/ j�3( CITY OF EVERETT BUSINESS LICENSE ii(REOUIHED)5O L153 <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: p '3 I <br /> gL <br /> r <br /> K/"�' � Ua JLI <br /> EMAIL; R&+(v/t�I'� -PI WQ(�fil(\Aj2Q14-�, <br /> /BUILDING PERMIT APPLICATION 1 <br /> Existing Use of Building: S f 1Z—c/o' + Contract Price of Work:$ 1 (0 l - _ <br /> Proposed Use of Building: 5 g7.-c-.14'1 © <br /> 1Fteat Source: Gas C Iectrlc ❑Other - <br /> Building Type: ❑SFR-detached ( FR-Attached ODuplex CiMulti-Famlly-#of Units: _ ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddltion DRemodel OgfRepair DT.I. CDSIgn DSrinkisr CiDemoiltion 0Change of Use <br /> DESCRIPTION OF WORK: <br /> fVY\ pUe_, / Y'21/4Q\A,GI✓ -eA-e(fh'r C— W a.-i- 1/\ c cit- 4 <br /> • ASSOCIATED BUILDING PERMIT#(If applicable); <br /> —MECHANICAL PERMIT APPLICATION - PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _Repair Type of Project: _Naw Arkin "--Alteration __Repair <br /> of List of Fixtures #of List of ^(urea #of (Jet of Fixtures #°f List of Fixtures <br /> Fixtures FlMufas Fbaufes Fixtures <br /> r -Air Handling +.is - . Ha - ump Toilet Backflow Preventernslde Bid_g) <br /> orced Air Systems It Healer Bathtub 'Urinal <br /> Gas Piping Boller Lavatory(Wash Basin) Drinking Fountain <br /> 1 'Water Heater - Refr aratlon Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Die•oeal Grease Ira. <br /> Gas_ Range Ducting _ Dishwasher _ Roof Drains <br /> lolhea D = 'ooku.8 Other: 0 Clothes Washer. _ _ Medical Gas <br /> Range ood Water Heater Other: <br /> Exhaust Fen Sink(Servlce/Bar/Mop/eta) Other: <br /> SPRIN�S1.E!R- y X5910 S WI •____ ..�� ___ <br /> clemlcal orate -of Heads _ <br /> ACKNOWLEDGEM NT: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,slater end focal few.The grentfng of a permit only euthorizes approved work and no deviations therefrom.Deviations must/Irat be authorized in willing hem the <br /> 9uHdag Official wore being authorized under any circumstance.I am the owner,or I em authorized by the owner of this property to perform the work for which eppiication is made. <br /> and/comply with rhe Stale Contractors Law 18.27 RCW and 290.200A WAG- <br /> City of Everett Official use Only _ <br /> !4! lr.n� ✓f l - PERMIT# nCr <br /> 61 iV . <br /> Own, uthor ze8 Ag at Signature Date Revised 9/23/2046 <br />