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Apr 24 2018 01:31 PM Washington Wat--�Heaters 8663757454 pagil <br /> 4crrPERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING l SIGN /SPRINKLER i DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810'( FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.govtpe nits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: //3 5s et 1i 0 •-1144— 'PROPERTY TAX#: Cet71"76C C/60(0() <br /> LEGAL for new colstruction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NANIE: ' ' 4 ti ,it i TENANT NAME(If Commercial): <br /> or( eVere4+ STATE LON z, 4 i <br /> OWNER <br /> OWNER <br /> CONTRACTOR ADDRESS: STREET ! it L. If(0 �-v.L 566 'OXS '2C� <br /> L. . �jJ <br /> CITY / Ct7 1/�i STATE t'+rf' QU 21' { O se. <br /> CONTRACTOR PHONE: 426-- — g'7/ CONTRACTOR EMAIL: 4 R • L it+ '6(L1 (U/i 1 <br /> CONTRACTOR LICENSE#(REQUIRED): 1,4)494,17-41gi crry OF EVERETT BUSINESS LICENSE*(REQUIRED): ,99 <br /> PRIMARY CONT CT: U OWNER I CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACTACfNAM'• f CONTACT PHONE: C�2 .- ' 3 7 <br /> _We' ! <br /> . I `-C l /t u i l- C 5 CONTACT EMAIL., �.0 tf4 1 - f i 1r i <br /> BUILDING PERMIT APPLICATION <br /> Existin. Use of B Min.: C _ 1 y� Contract Price of Work:$ l /' <br /> Proposed Use of 3ulidin9: Heat Source: ❑Gas ectric Dottier <br /> Building Type: LSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industr <br /> ypeofProject: EINew °Addition ❑Remodel I:Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change_pi'Use <br /> DESCRIPTION CF WORK: <br /> ReAC:i -&p/au 1 J c/ nC� 1r0 . i E) <br /> ASSOCIATED Bt✓CILDING PERMIT# if a.•licable: Allillk <br /> Ami.i.rw■a.,r� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION jell F <br /> Type of Project: _New„ Addn Alteration Repair Type of Project: _New ,Addn Alteration ' <br /> #of LW of Fixtures #of #of It of <br /> Fixtures Fixtures List of Fixtures List of Fixtures Li.-t of Fixtures <br /> Fixtures Fixtures <br /> NC—Air Handling Units Heal Pump Toilet Backflow Praventer inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pir ing Boiler Lavatory(Wash Basin) Drinking Fotntain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Firapiace Wood Stove Ktchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range -toed / Water Heater Other: <br /> Exhaus,Fan Sini<(ServicelBar/Mopietc,) Other: <br /> • SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads - <br /> ACXNOWLEDGEvfeivr,•i have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this parnit must comply Min <br /> current federal,state,and local raw.The granting ora 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 are the owner,or I are authorized by the owner of this properly to perform the work for which application is made, <br /> end i.cgmply with the State Contractors Law 1e27 ROW and 295 200A WAC. <br /> City of Everett Official Use Only <br /> ta11:47t.ppl �4_( <br /> Cw1 1 j <br /> ii Authorized 'gent Si ature =--- -�---� <br /> t.. Date (Revised 5120/201 6) <br />