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Jan 23 2019 11:27AM Washington V Heater's 8663757454 p� <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> #11111 "..1 <br /> :r CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettepseeverettwa.gov j www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (73 Co(/ 1� l-7l WTI <br /> I O�+ <br /> �'" ll (PROPERTY TAX#:[jLX-11- x.( f <br /> LEGAL for new Construction: Short Piet/Subdivision <br /> Lot No. (attach Copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNCR NAME:WI,\ 7.1)0.0 L TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET fat 1i r+f`3 <br /> CITY a err, . STATE ZIP . +1' Q <br /> OWNER PHONE: 0 ^M— 56 OWNER EMAIL: <br /> CONTRACTOR NAME: W PrS (lion. i A 'A--v& r r <br /> CONTRACTOR ADDRESS: srReer I1I Z��/�lap -z Alet 5e — '6 s 9 DX L g <br /> CITY R e L�]jC/I t STATE if+ <br /> CONTRACTOR PHONE: '1;4'4g3-,�rf`7g7I CONTRACTOR EMAIL: WI614, fl-/VAC 4m `Lo O <br /> CONTRACTOR LICENSE#(REQUIRED): Wil-rotLF- ,'if/' .,..y CITY OF EVERETT BUSINESS LICENSE#(REQUIRED}: 0 9' <br /> PRIMARY CONTACT: 0 OWNER 1 ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME,;,._n y CONTACT PHONE: Cl2, ,- g9_C/ 7/ <br /> .. i &111 1 r s CONTACT EMAIL. a _ <br /> 6441 -JAL N�C.,�C�tar!xt-1L.(0)41 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building; &At0,J Contract Price Work:$ 1.W1 <br /> Proposed Use of lens: Heat Source: s OElectric D <br /> ` Other <br /> Building Type: R-Detached ❑SFR-Attached ODuplex OMulti-Family-#of Units: DCommerciai 11 .ustrial <br /> Type of Project New ❑Addition DRemaodel ❑Repair OT.I. OSign OSprinkler ❑Demolition ©Change •f Use , <br /> DESCRIPTION OF WORK: <br /> etill0-1AL 14 ( Ai <br /> 0 a..5 � K elle' <br /> ASSOCIATED BUILDING PERMIT# if a I <br /> ( pp fcablq <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION -, <br /> Type of Project: _ New Addn Alteration Repel 4•> Type of Project: — New Addn Alteration _Repair :7,%~1 <br /> #of #of #o{ <br /> Fixtures <br /> List°{!fixtures List of Fixtures List of Fixtures #of tom' <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> A/C--Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg}) - <br /> Forced Ar Systems Unit Heater Bathtub <br /> Gas Piping Boiler Urinal <br /> 1 Water Heater Lavatory(Wash Basin) Drinking Fountain <br /> Refrigerapa 1 Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher <br /> Glatlties Diyei Hookups 'Other: Clothes Washer Medicat <br /> Medi drains <br /> Range Hood cal Gas <br /> Exhaust Fan Water Heater Other, <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> !Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this epplkation el7d confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit onlyaufhcrizes approved work and no deviations therefrom.Devietlons must first be authorized in writing from the <br /> Building Oficial before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this prepertyto perform the work for which application is made, <br /> and I comply with the Stale Contractors Law 18.27 RCW and 298.200A WAC. <br /> Lek <br /> city of Everett Official Use only <br /> `-z ippm#v:,k0(.... O O <br /> O ner/Authorized Agent Signature Date <br /> (Revised 51i0/20 re) <br />