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03/07/2018 WED 13: 04 FAX 425 415 6867 Fast water Heater Ej005/005 <br /> V I Og"(ID <br /> ,‘P' PERMIT APPLICATION <br /> Y BUILDING/MECHANICAL/PLUI1IIBING/SIGN 1 SPRINKLER I DEMOLITION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> • <br /> (P)425257-6810 I FAX 42S-287.8867 I(E)everettepseeverrtlwa_9ov I www.everettwa.gov!permlte • <br /> (Blue or Black Ink Only Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: MirarilliM v PROPERTY TAX#: I an I I to QUI / ry <br /> LEGAL for new construction: Short PIalleubdtvIelon Lot No. (attach copy of Iona legal descrfptton) <br /> CONTACT INFORMATION <br /> OWNER NAME; Da(it $j S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: emsEr 30 050 141Alj _ 7ry��J�) <br /> Cr" 'A �Ai STATE(A/A'''. ZIP I�$C" 3 <br /> OWNER PHONE: W - ) of k' OWNER EMAIL: <br /> CONTRACTOR NAME; d't AI ?-_AT��I 1�- <br /> CONTRACTOR ADDRESS: STREET 1 J f .t_ :1�. 61r- I ()(n <br /> CnY 12 �1..... STATE $AJ 11p 1 g D 1 <br /> CONTRACTOR PHONE: ~E o�5 to'j� `CONTRACTOR EMAIL:F. V#1 17 S (o 41s--vJQ r(Wa r• p . <br /> CONTRACTOR LICENSE#(REQUIRED): '4 SrVi r ; $C., CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)5-0 45-3 <br /> 3 <br /> PRIMARY CONTACT: 0 OWNER !Lo: CONTRACTOR LSI OTHER(Please Specify) <br /> CONTACT NAME: ' CONTACT PHONE: <br /> 1 : L-- CONTACT EMAIL: Q i/l/i,•I- -F a I AA nn��'.�4W, W <br /> BUILDING PERMIT APPLICATION . _ <br /> 14, Existing Use of Building: �7fp " Contract Price of Work:4....1,„328____ <br /> Proposed Use of Building: 5 FP _ Heat Source; yIoas DElectrIc CDOlher _-* <br /> Buildin: •e: K. FR-Detached GSFR-Attached ODu•[ex DMufti-Famll -#of Unite' EICommercial Olndustrlal <br /> Type of Project: ONew DAddition DRemodel IA Repair ©T-I, ©Sign I lSprinkler DOemolltion ❑Change of Use <br /> DESCRIPTION OF WORK: y <br /> o\ie / \l'eLPlA.ce elPr-S w a.A-er 1n c a-\-t <br /> ASSOCIATED BUILDING PERMIT#(It applicable): <br /> MECHANICAL. PERMIT APPLICATION .� . PLUMBING PERIVIIT APPLICATION �---- <br /> Type of Projsei: __New Addn _Alteration Ropalr Type of Project: New _Addn Alteration _Repair <br /> #of /Jai of Fixtures #of ' #of ' #of <br /> Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-Air Handling Units Heat Pump . et -Backflow Preventer h=de Bldgj <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> ` �d Gat:Piping i30118-1- V A Leveto Wash Pasln DrinTlnt Founta, ' - <br /> I�I`/) Water Heater Refrigeration Shower Floor Drain <br /> Gas Flreplace . _ Wood Stove Kitchen Sink&Disposal Grease Tr. •• <br /> Gas Range _ Ducting •Ishwasher Roof D • fie <br /> -clothes Dryer Hookups Other: — ••thea Washer r.• al Gas <br /> Range Hood _ Wa+= Heater <br /> Exhaust Fan - _ - Sink(Sce/Sar/Mopfeta) Other. <br /> SPRIN -- - - -eiSSIO -1fsTh°M _ . T <br /> aurical or . _ , , ..of Heads <br /> ACKNOWLEDGEMMNT:I have reviewed this application end confirm the Intormalion contained herein is true end correct.Work done pursuant to this permit must comply with <br /> current Wend,stela end lose!law,The granting of a permit only sothorizes approved work and no deviations therefrom,Deviations must Brat be authorized In writing(rem(he <br /> Fulkding Official befoie being euthorized underany circumstance.I am the owner,or!em authorized by the owner of this property to perform the want for which apoIfcellon is made. <br /> and I comply with the State Contrectors Caw 10.27 RCW and 29a2.00A WAG <br /> City of gverett Official Use only <br /> 41 A �, 1 ; 3 . - I�jq',bt 1 e03_,8 PER6 2 <br /> Own-' •uthor za:Ag-at Signature Date (Revised 9/23/2098 <br /> 1 <br /> ... <br />