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#01111 11111 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER I DEMOLITION <br /> Cr TrY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425.257-8810 I FAX 425.257-8857 I(E)everetteps©everedwa,gov I ,I.A.gw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1.4-W2.. Oar V%rKltar-N u-t (A7_D-6 PROPERTY TAX#: 001-4 V-11,0000.5c40 <br /> LEGAL for new constrtIctsol Short Plat!5uOdivis;on Jot No (attach copy of long legal descriphon) <br /> CONTACT INFORMATION <br /> ... . <br /> OWNER NAME: ry-lwrk -"5-t•c..elk-r-r5 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: S TR E'E T. 4 VZ. Dar VI rttert,r, tan <br /> STATE (.4..)1:‘ ZP <br /> OWNER PHONE: "2_,0G- 13 ‘-cr-tc:sn OWNER EMAIL: <br /> CONTRACTOR NAME Brennan Heating <br /> CONTRACTOR ADDRESS: SITMET 4601 S 134th PI <br /> CU Y Seattle STA1 E Wa ziP 98168 <br /> CONTRACTOR PHONE: 206-248-7900 CONTRACTOR EMAIL: Jaimie@brennanheating.corn <br /> CONTRACTOR LICENSE#(REouiRED): BRENNHA971R9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 028230 <br /> PRIMARY CONTACT; DOWNER pt CONTRACTOR 0 OTHER(Please Specify) . <br /> CONTACT NAME: CONTACT PHONE: 206-248-7900 <br /> Jaime How CONTACT EMAIL: Jaimie@brennanheating.com <br /> BUILDING PERMIT APPLICATION _ <br /> ExOZ <br /> isting Use of Building. Contract Price of Work: $ _ ---- ----- <br /> Proposed Use of Building Heat Source iiigGas 0Electric 00ther <br /> Budding Type OSFR-Detached abIR-Attachod ODuplex 0Multi-Family-II of Units: 0Commercial Olndustrial <br /> Type of Project: ONew OAcidition ORemodel ORepair OT.I. 0Sign Sprinkler ODernolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ••4--7- <br /> k..)3 <br /> , f i cx._ fr3 <br /> ASSOCIATED BUILDING PERMIT#(it applicable), <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration N(Repair Type of Project: Now Addn _Alteration )(Repair <br /> #of ft of #of #of <br /> List of Fixtures List of Fixtures Fixtures Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> NC—Air Handling Units Hoof Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> i Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater((, . .3) , Refrigeration Shower Floor Drain <br /> Gas Fireplace' Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> — <br /> Range Hood Water Heater Other: <br /> . . . <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical Or Water _ No. of Heads <br /> ACKNOWLEDGEMENT,i have reviewed this application and confirm theopformation containeef poreirr is true and=Teo,Work done pursuant to this permit must comply with <br /> current Wane,state,and local law The gr4wiling of a permit only'actlhOriZeS approved worn and no deviations therefrom.Deviations must first be authonzed in writing from the <br /> Building Official berate being autnunzug imaer any circumstance,I am mu wrynuf,w i om authorized by the owner of this property 10 perfotEn the work for welch opplicatioo:s made, <br /> and I comply with The State Contractors Law 18 21 RCW and 296 200A WAC <br /> City of Everett Official Use Only <br /> }\-C"--"—re•-1-1/63 '2.'2)-l cik PEns o5 <br /> ... oc , 2_ <br /> 0 ner/Authorized Age t •ignature Date (Revised 9/23/2016) <br />