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08/10/2017 THU 11: 54 FAX Fast Water Heater /003/007 <br /> 1 1) i-- -sq <br /> • <br /> 1!!!! 1-iPERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> l` 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettapst everetlwa-gov I wuw.everettwa.gov/permite <br /> Blue or Black Ink Only Please PROJECT SITE INFORMATION mi <br /> \- <br /> SITE ADDRESS: C Op V( )P f✓ f El )E l pro PROPERTY TAX 0: 0011 / CV -* <br /> LEGAL for new construction: Short Piet/subdivision Lot No (altsch copy of long legal description) <br /> CONTACT INFORMATION ..- <br /> _ " <br /> OWNER NAME: D 0 f 11 11111,46 Mg A TENANT NAME If Commercial): ""ice <br /> OWNER MAILING ADDRESS: smearL j DbDL ' A 11 , l r_ r�� <br /> coy arae c✓V k. 21Pc /Jv <br /> OWNER PHONE: 4 F 5 /(4J OWNER EMAIL: --� <br /> CONTRACTOR NAME; �.� S'1 k ;r •'e-i T <br /> f. <br /> CONTRACTOR ADDRESS: 8Ti:EEr `\2 1 N C!V1?P_. 'QK S " C t D(', <br /> pri�m"" 1 S"L _ srn ne f k zip ^ ,,1 q_\Q <br /> CONTRACTOR PHONE: ("'` 5 1U_3u C CONTRACTOR EMAIL:P lz,mITS p-I - O is Vla/-�eir., OKI <br /> CONTRACTOR LICENSE tf(REQUIRED)r 'rIA `'ljq LI ggjG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) OC 53 <br /> PRIMARY CONTACT: L=1 OWNER ( r CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: La as-� ,3..„ 1"L <br /> `\' i 1 � CONTACT EMAIL: Vy/1d"� ..EW9f-0300.. v \ p . ("OW <br /> • BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ L T. _ <br /> Proposed lies of Building: '� Heat Source: Gas ❑Electric ❑Other <br /> Building TyptrtFR-Detached OSER-Attached ❑Duplex CiMultl-Faml(y-#of Units OCorrfinerdal Dindustrial <br /> Type of Project: ONew Iw7Addltion JRemodel CRIRepair, CIT.I. CISIgn ❑Sprinkler LIDemolltion DChange of Use <br /> DESCRIPTION OF WORK <br /> f‘IY) eve / reQ\a.ce CSS wok ea-t- <br /> ASSOCIATED BUILDING PERMIT 0(If applicable): <br /> MECHANICAL PERMIT APPLICATION PL •. PERMIT APPLICATION <br /> Type of Project: _._New Addn _,Alteration Repair Type of- •Ject. _New ddn Alteration Repair <br /> xt <br /> Fixtures, List ofFixtures FixturesList of Flxturea z u�8 List of Fixtures f v List of Flit e res i <br /> NC--Air Handling Units Heat Pump Toi=t Backflow Prey rrneide Bldg) <br /> ti Forced Air Systems <br /> Unit Heater B, htub Urinal <br /> Gas Piping <br /> Boller L votary(wash Basin) DrIn kin ountiln <br /> --(3 Water Heater - - Refrigeration S ower Fi rain <br /> Gas Fireplace Wood Stove tchen Sink&Disposal reams Trap <br /> Gas Range Ducting D=hwasher ” <br /> • � Rod brains <br /> Clothes Dryer Hookups _ Other: CI. hes Washer _ Medical(as <br /> Range Hood Wat- eater Other: <br /> Exhaust Fan Sink Sery ce :ar/Mo•etc. •ther: <br /> . SPRIN , �SuPEgj at0 'r111I <br /> arnica!or W Isla of Heads <br /> ACKNOWl.Rl7REIWNT`I have reviewed this application end coniHrn the Mformellon contained herein le true end correct World done Foment to OIL?permit must comply with • <br /> current federal.stela;end local law.The granting of a permit only euthorfzes approved Wert and no deviations therefrom.Deviations must f/rat be authorized/n writing horn the • <br /> Building Official beloke being authorized under any circumstance.I ern the owner,or!em authorized by the owner of this property to perform the work forwhnch application is made, <br /> end/comply with the Stele Contractors Law 19.27 ROW end 290.200A WAG. <br /> City of Everett 01'110141We Only • <br /> 41 II 10 i ?-, to .'l PERIM • <br /> Mt& . 4".......s.L. n 00. 0 (t1 . , <br /> Own,' •ulhor ze%Ag: Signature Date (Revised 0/0/!W ) <br />