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<br /> PERMIT APPLICATION
<br /> 161111 BUILDING/ MECHANICAL/ PLUMBING I SIGN I SPRINKLER/DEMOLITION
<br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 88201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govfpermits
<br /> (Blue;or Black Ink Only Plr,aae) PROJECT* ,,,t101001010010111:::%3;;:
<br /> PROJECT SITE ADDRESS: q--4., - - j 4,m,.... u> goo 5 PROPERTY TAX#: O oQ 5 1600 9g 0*-3 cc
<br /> LEGAL for new construction: Short Plat/subdivision Lot No._� (attach copy of long legal description)
<br /> I. .,.z l...x VJ,C®v'1. -.','.47,4;,k-
<br /> �s¢'w.Z 9^'4 K 1 r l �,
<br /> "`Os`T>At riiiftc„I A" i s F r
<br /> OWNER NAME: Q-..0 yl 1,-,c, -L I t,,I, O1 TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: s]SEIT q q - 1er-I"" AV-4— tio. 13 9 0 `4 j } i j
<br /> CITY 'IL;N.H.,/ &k STATE("0 0.' ZIP Cift GX 3....
<br /> OWNER PHONE: , ,P.p 5 if 9q,P OWNER EMAIL:
<br /> CONTRACTOR NAME:Brennan Heating
<br /> CONTRACTOR ADDRESS: sTREE74601 S 134th PI
<br /> CIiY
<br /> Seattle STATE Wa ZIP 98168
<br /> CONTRACTOR PHONE:206-248-7900 CONTRACTOR EMAiL:jaimie@brennanheating.com
<br /> CONTRACTOR LICENSE#(REQUIRED):BREN NHA971 R9 !CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 028230
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-248-7900
<br /> Jaimie How CONTACT EMAIL:jaimie@brennanheating.com
<br /> '' BilN bli o° NN MIV Ti N n ; .. ,i
<br /> Existing Use of Building: Contract Price of Work:$ l''i 0
<br /> Proposed Use of Building: Heat Source: OGas Ilectrio OOther L.
<br /> BUILDING USE: ®SFR 'I"ownhouse DDupiex DADU ❑Multi-Family-#Units: ©Commercial DAccessory Structure
<br /> Type of Project: ONew DAddition DRemodel DRepair EEh' : OSign ©Sprinkler I I:Demolition ®Change of Use
<br /> DESCRIPTION OF WORK:
<br /> a (.,.. -4 V-,t C. -t-r 1 C. L4) &J—` l-. . .. -
<br /> 2_,L-t \G . Voir LI t
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION --% -. v £ 7110#01,:• PP KATION
<br /> Fixture Fisturtr Fixture Fixture
<br /> count List of Fixtures coyer List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> NC-Air Handling Units Gas Piping Backflow Proventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer r Sink-Commercial(3-comp,prep,tloor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher t Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilation\ Floor Drain Toilet
<br /> Exhaust Heed(Type I) (Not HeatiAC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) 'Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove t Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other. Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains l Water Heater( . ,f c)(11 c.,)
<br /> 'SPRINKLER 1 SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other.
<br /> Water Suppression System No,of Heads
<br /> Chemical Suppression System ` No.of Heads
<br /> ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained heroin is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,state.anti local taw. Tho granting of a permit only authorizes approved warn and no deviations therefrom,Deviations must first be authorized in writing fmm the
<br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by(he owner of this property to perform the work for which application is made,
<br /> and I comply with the State Contractors Law 18.27 RCWand 2C6.2110A WAC.
<br /> City of Everett Oficial Use Only
<br /> J _ r PERMIT#
<br /> ' `' it-4--' 4.
<br /> ( t 1 1'1/11, l'''( pf - ,(, ,I
<br /> Owr1Li/Authorized Agent Signature Date (Revised 10/101/2018)
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