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0 3/01/201 6 TUE 12: 08 FAX 4252521666 CM Heating ZOO <br /> #47-T PERMIT APPLICATIC <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 08201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everettepsgevereltwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (pi b"I lrl Sy „V I PROPERTY TAX 4: <br /> LEGAL for new construction: Short Plat/subdlvISlon J Lol No. (Munch copy of long loyal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: \Ctk, C,haprriCtil TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET (p IA ,L sr 3\A/ <br /> CITY /Ve STATEZIP `[��D. <br /> OWNER PHONE: 20( 335 521 OWNER EMAIL: <br /> CONTRACTOR NAME: CrY1 e AT I cI6" <br /> CONTRACTOR ADDRESS: sTAE_T1 L-�1J <br /> �I t) BIZ°adU)3 q <br /> CITY l�o,/0: <br /> �- STATE WA ZIP q g2_0 <br /> CONTRACTOR PHONE: ' S 259 05"9-0 CONTRACTOR- EMAIL: VN�{7e(t D 1 �� ,_ ch�►'D'1 <br /> CONTRACTOR LICENSE#(REQUIRED):rmh.� [dillCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1 0C1) <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER (Please Specify) <br /> CONTACT NAME: /� CONTACT PHONE: 4.7E,25 Q <br /> NeRdk - Cj I t l 1:,p t/�!6' CONTACT EMAIL: Male t 0 an(`W' Li�1 1,IC Cali <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ t-{ 03 <br /> P_noosed Use of Building Heat Source: ae ❑Electric Daher <br /> — <br /> Building Type: ❑SFR-DetachedQSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerclol ❑Industrial <br /> TypeProject: El New Yp of Addition ❑Remodel ❑Repair ❑T,I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Uao <br /> DESCRIPTION OF WORK: <br /> ins-voi diAcyf-icts IrtDi- pu,n-ip <br /> ASSOCIATED [BUILDING PERMIT# If a••Ilcable): <br /> MECHANICAL PERMIT APPLICATION .PLUMBING PERMIT APPLICATION <br /> Typo of Protect: New Addn _Alteration `Repair Typo of Project: _Now _Addn _Alteration _Repair <br /> Fixtures fi <br /> List of Fixtures •Flx u AB List of Fixtures #of List of Fixtures of Lief of Fixtures <br /> Fixtures Fixtures <br /> A/C-Alr Handling Units JHeal Pump • Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems i Unit Healer Bathtub Urinal <br /> Gas Piping Boller Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater 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 /> Range Hood Water Heater Other: <br /> Exhaust Fan SInkSServIce/Bar/Mop/etc1 Other. — <br /> :;SP RI ,S,UPP.RIESSION.8YSTEM - <br /> INumber of Heads <br /> t <br /> ACKNOWLEDGEMENT;I have reviewed this application and confirm the information contained herein is true end correct, Work done pursuant(o this permit most comply with <br /> current federal, stale, and local law. The granting of e permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance,I am the owner, ort em authorized by the owner of this property to perform the work Iv which application Is made, <br /> end I comply with the State Contractors Lew 18.27 ROW and 286.200A WAC. <br /> City of Everolt Official Use Only <br /> / / 4 ,i T / r^ PERM T /.. <br /> Owner/� I , J I lX I�` ' L C J D0 ' <br /> Authorized Agent Signature Dole (Revised 10/12/2015) rrll <br /> ( VJ ✓• <br />