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Jan 23 2019 11:27AM Washington W Heaters 8663757454 IN- '' <br /> PERMIT APPLICATION <br /> #4 ' BUILDING i MECHANICAL I PLUMBING / SIGN/SPRINKLER i DEMOLITION 1it <br /> J CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 i(E)everelteps@everetlwa.gov I www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION �I�,/ <br /> PROJECT SITE ADDRESS: a t S 10C.) --5+- 5 ) - Lc g PROPERTY TAX#: Y/�1 k IU <br /> ll <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:L` A 1 MC r.i. <br /> rrr\CLC_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET( 1 5 ,(/��") cr 3-0 <br /> CITY i...vere l-�� (An �^?/O <br /> +` ! STATE ZIP ��!✓i L'"1 <br /> OWNER PHONE:a00"q I -St`?� OWNER EMAIL: <br /> • <br /> CONTRACTOR NAME 1,€)A501 iota-Th/1/4) V r4-16t2 t---/1°TMc$ <br /> CONTRACTOR ADDRESS: s-rReer /-1I5 2. 111, U - ?4-V 5 — PO <BOX ?2OJ k <br /> CRY W I J V ti STATE (lib LIP qgs 5f <br /> CONTRACTOR PHONE: 412-6--g/K3– L`g'7, CONTRACTOR EMAIL: wh-t,Jf3- Dvfic CO6t(Lv aim <br /> CONTRACTOR LICENSE#(REQUIRED); WI1"5'LU- iO!!f .s._ )CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05 3W <br /> 9 <br /> PRIMARY CONTACT: 0 OWNER ( CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME' CONTACT PHONE: C2C gg3-ca7/ <br /> KJ/4-(C 1 D:1-J1(-(I5 CONTACT EMAIL: " fI} IC/ (_@6 w <br /> L,.(i f, <br /> \ � BUILDING PERMIT APPLICATION �} <br /> Existing Use of Building2 Sc\ c- \INCLA Contract Price of Work:$ r l.V— <br /> Proposed Use of Building: Heat Source: ❑Gas ectrio 00t her <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex !tl-Family.*of Units:' ❑Commercial ❑Industrial <br /> Type of Project: :New ❑Addition ❑Remodel ❑Repair ❑T.!. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPT ON OF WORK: <br /> i 11-11/4610-- j EleCk164 J/ 444i+ 2 �/(S <br /> C <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION (( `\, <br /> New Addn Alteration Rope <br /> Type of Project: New Addn _Alteration Repair Type of Project: a fl <br /> Od <br /> #of _ — — s....�r <br /> Fixtures list of Fixtures #of List of Fixtures #of List of Fixtures #°! <br /> Fixtures Fixtures Fixtures List of Fixtur <br /> NC-Air Handling Units ' Heat Pump Toihet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler _ Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower <br /> Floor Drain <br /> Gas Fireplace Wood Stove _ Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher 1 Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood , I Water Heater Other: <br /> Exhaust FanSink(Service/Bar/Mop/etc.) 'Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> !Number of Heads " <br /> ACKNOWLEDGEMENT:t have reviewed this application and confirm the information contained herein is true end correct.Work done pursuant to this permit must compy with ` <br /> Current fedeia!,state.and local law. The granting of a permit only authorizes approved worts and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any cricumstance.i am the owner,ort am authorized by the owner of this properly to perform the work for which application is made, <br /> end I comly with the State Contractors Law 18 27 RCW an d 246.200,4 WA C. <br /> c.„..____es,\ <br /> t. <br /> L'hl ij'al4J-3 1 '23 1 City of Everett Official Use Only <br /> Owned thorized Agent Signature <br /> Dale (Revised 5/20/2.016) <br />