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02/06/2018 TUE 19: 05 FAX Faet water Heater U005/007 <br /> F-6 ,?-/o <br /> PERMIT APPLICATION <br /> '"-. BUILDING I MECHANICAL/PLUi1IIBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> / j' v" ' 32D0 CEDAR STREET,EVERETT,WA 00201 <br /> (P)426-257.6010 I FAX 425-257-9857 1(E)everettope@everettwre.gov I www.everottwa.gov/permits <br /> •51aee or Black Ink Orel Please) PITOJIPOT SITE INFORMATION <br /> •• <br /> AP <br /> PROJECT SITE ADDRESS: r-,AD P a PROPERTY TAX#: � � O O/./ 0. yy <br /> LEGAL for now conetructlon: Short Pi atisubc(fvlsion Lot No. (attach copy of long legRI description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /______. C175--- TENANT NAME(If Commercial)_ <br /> OWNER MAILING ADDRESS; 9rn n11 1 im f' au-I' <br /> OWNER PHONE: 9' j Lo 14 i OWNER EMAIL: — <br /> CONTRACTOR NAME: ft' ST L ti 1. g 01.,.C ___--16 .: , c / r <br /> CONTRACTOR ADDRESS: ermeEr W+ 1.5-- N .t—v�!� J 1 , D l/{J1/��' - � <br /> ___________L____ 1,...( CfTY 'YJ - - 8TA7H LA.E1 1 2IP 0 iJ D\]-- <br /> CONTRACTOR PHONE: _l d S (p3 /�3 CONTRACTOR EMAIL:P 1.X V 1T� SVv -1'UU O /�, , (AVI1 <br /> CONTRACTOR LICENSE#(REQUIRED);f�-S"'j wW"c\�g 5G CITY OF EVERETT BUSINESS LICENSE#r(REQUIRED)5DC 5 3--, <br /> PRIMARY CONTACT: ❑ OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n V L CONTACT PHONE: t_1, -5-- .3 Li, �L/I <br /> K�� li t 1 �� CONTACT ENTAIL: Q.eArtiv("� ,c-t Ita)Qt ,�`/'� !,c -Y'• r/t <br /> BUILDING; PERMIT APPLICATION <br /> • <br /> ,v. Exfsttnp Use of BulldIng: f•/ Contract price of Work:$ .,,. ft��' �_,_ <br /> Projosed Use of B iidlna: ST- Heat Source: ❑Gas Pflectric ©Other ..._ . <br /> Bulldln• T pe: X R-Detached ElSFR-Attached LIDu.Iex UMultt-FAmll -#of Units: DCommerclal ©Industrial <br /> Type of Proct: UNew DAddltfon LRamodel I::ARepair DT.t. Clsign ❑sprinkler ❑Demolition CDChenga of Use <br /> DESCRIPTION OF WORK: .1— <br /> ' \11no\i-C / fe,p\A,Ce., ef_..c-h- )- c_ tA)00--eir V\ c <br /> ASSOCIATED$UILDING PERMIT#Of applicable): <br /> YMECHANICAL PERMIT APPLICATION �_ PLUIMI81NGI PERMIT APPLICATION <br /> Type of ProJect: _New _ Addn _Alteration Repair Type of Project: Now _Addn _AIteratlon _Repair <br /> Fly of List'of Fixtures F oras 1-let ofF. ores Flxtoras list of Fixtures 1'Urtu of <br /> List of Flxturea LL <br /> A/ r Hand1131:»its Heat••mp _ Toilet Backflow Prevonter(Inside Bldg) <br /> orced Air Systems Up Heater Bathtub Urinal <br /> Gas Piping :oiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater . ,.'efri.eretion Shower Floor Drain <br /> Gas Fireplace "•od Stove _ Kitchen Sink&Disposal V Grease Trap <br /> Gas Reno Duc A eDishwasher Roof Drains _ <br /> olhes Dryer!V-oupa _ Other: Clothes WasherMedica_I G_as <br /> Ran go Water Hater - other. <br /> Exhaust Fen Sink(Service/Ear(Mapletc.) Other: <br /> - <br /> sPttl6a .Et�t SilPp Esslo[�s sT M <br /> ._ - - <br /> emlcal or W of I.-loads <br /> A CKNOWLEoGEMMNT;/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,stele, and local law.The Brent/ng of a permit only authorizes approved work and no deviations therefrom.'Deviations must first be authorized In writing from the <br /> Building Official bafora being authorlied under any cfcumstence.)em the owner, or I em authorized by the owner of this properly to perform the wont for which application is made, <br /> and/comply with(he State Contractors Law 18_27 SOW and 288.200A WAG <br /> f fl / ( City of Bverett Official Use Only <br /> ', I /, / /I _ (.,( PL� PER L T <br /> 11 <br /> Ownzr uthorza.Ag: Signature Date (Revise3/2016) <br />