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12/05/2017 TUE 13: 41 FAX Fas€ water Heater U004/008 <br /> PERMIT APPLICATION KOOS6 <br /> BUILDING I MECHANICAL 1 PLUMBING I SIGN/SPRINKLER/ DEMOLITION <br /> /:4:14CITY OF EVERETT PERMIT SERVICES <br /> 3200 GEOAP.STREET, EVERETT,WA 913201 <br /> (P)425257-8810 I FAX 425-257-8857 I(E)everettopseeveretlwe.gov I www-everettwe.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT,SITE INFORMATIOPI 1 . <br /> PROJECT SITE ADDRESS: Q 3 P Pi: 5 PROPERTY TAX#; r a��l ll� �/ <br /> •LEGAL for new construction' short Piet/subdivision Lot No, (attach copy of long legal description) C� <br /> CONiTACT INiFORMATION <br /> OWNER NAMC, --Ef11elif� TENANT NAME Of Commercial); --- <br /> OWNER MAILING ADDRESS; wriest' 13 (bt3_e D pi, SE_ <br /> � ,� <br /> onY Ai A / ■ 8TA7E� �/�y7 Zlr+ -{ 5�6 g- <br /> OWNER PHON4a_� <br /> E: �! p "P.3 OWNER EMAIL: - ii <br /> CONTRACTOR NAME: ¶PgST UlAo r~t-apT moi,. <br /> CONTRACTOR ADDRESS; BTREGT �- I mo, N CX f -. ku)� S G D co <br /> CONTRACTOR PHONE: (-V s .()3\„, M CONTRACTOR EMAIL:P'e Uy) 1T p „S')"IU ,,((ky } �OYM <br /> /',.� <br /> CONTRACTOR LICENSE#(REQUIRED):f A S"rw oil° 1 113C... IT <br /> Guy OF EVRTT DU9INEet3 LICENe #( <br /> EREQUIRED) 0ti53 <br /> PRIMARY CONTACT: ❑OVVNER (x CONTRACTOR I=I OTHER(Please Specify) <br /> CONTACT NAME: /� �/ \ . CONTACT PHONE: n,/L('�� '3 cps ,Q�/( m <br /> >� l -t 1 �� CONTACT EMAIL: P"t/Y vvt;1 S ���1 (� "l r►p _• v�y I <br /> BUILDING PERMIT APPLICATION <br /> ExIetfn! Use of Sulldine: Contract Price of Work:$__._,. -1I f3, L - .._ <br /> Pro.osed Use of Sulfding; r Heat Source: r:1 Gas ❑Electric ❑other <br /> Building Type:t4SFR-Detached CISFR-Attached ❑Duplex LIMuitl-Famiiy-of Units:__ C1Commerclal Dindustrtal <br /> Type of Project: ❑New ClAdditton ❑RemodelRepair MT.!.' DSign DSprinkter ❑Demolition CUChenge of Uae <br /> DESCRIPTION OF WORK: <br /> D ie / re,Q\ CI° 6/c\--s ►A)G*eili C at-e <br /> ASSOCIATED BUILDING PERMIT#(IP eppllosble):-. .. <br /> MECHANICAL PERMIT APPLICATION ---• PLUMBING PERMIT APPLICATION _ _ r <br /> Type of Profwat; _Naw _ Addn _Alteration Repair Type of Project New Addn _Alteration Repair <br /> yrtaa U Lief of Fixtures Fixtures List of Fixtures Fixtures Fixtures <br /> &tures #of List of Rye?Ftxtur®s l <br /> Al-AIr H <br /> � andIlri Unite Haa9t Pum ()lief _ _ Baafcftow Preven ,. Inside Bid• <br /> Foraed Alr Systems Unit Heater athtub Urinal _ <br /> Gas Ppin9 Boller ,Levato Wash Basih Drinklnt F. taln <br /> . ipiWater Heater Refrigeration Shower Floor D =n <br /> Gas Fireplace Wood Stove 4Kitchen Slnlc&Dlepeaal Gr•-•e Trap <br /> Gas RonUe Duotlnsj Dishwasher - — -.•of Drains <br /> Clothes Dryer Hookups Other' _ lothes Washer ' Me Gas - <br /> Range Hood ater Heater Other: <br /> �-_-- Exhaust f'an ._ SI (Service/Bsr/Mopyetc�) Other: <br /> _ SI RINKIMR-4SUP_PAESSIOWS-V51TM <br /> ciemical or,Y , of Heads <br /> ACKNO WLEDGEM IJ7'I have revlawed(hie epplica(lon end confirm the Inform®(len contained herein is true and correct.Werk done pursuant to this penult must comply with <br /> current federal,state,end local law.The granting of a permit only authorizes approved work and no devlstlons therefrom.Reviatlons must first be aulhorlxed in writing from the <br /> Building Oiffclei befan3 Being authorized under any clrcumsteece-I en]the owner,art am authorized by the owner of this property to perform the work for which application Is made, <br /> and I comply with the State Contractors(,ew 15.27 ROW and 2a5.200A WAC. <br /> Oily of Everett Official Use Only <br /> -5 ' ! J..1 . L2 — o2ft1 <br /> Own uthor za�d A signature Date Revised 9123/2016) <br />