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03/21/2016 MON 15: 13 FAX 4252521666 CM Heating 0003/003 <br /> PERMIT APPLIATI <br /> BUILDINA ) 6ECHANICAL/PLUMBING CSIGT19R,NKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257.8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permlts <br /> ,;;, "''�ii'�,•t,i, ,.at.•:;-;y,a : .' �,ll;°.u,,. . -; ��.5 ';i..'`':R�OJE�'T '�iIITEINF,bRNiATION , , , <br /> PROJECT SITE ADDRESS; ROPERTY TAX#; <br /> LEGAL for now construction: Short Plat/subdlvlslon Lot No. (attach copy of long legal desorlptlon) <br /> `CrONfAGT,IiIi O ATION <br /> OWNER NAME: TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: STREET <br /> CITY 9 0 STATE ZIP V <br /> OWNER PHONE: — OWNA EMAIL; <br /> CONTRACTOR NAME: o <br /> CONTRACTOR ADDRESS: STRUT <br /> CITY STATE 2:P C�L� <br /> CONTRACTOR PHONE: 4GS RER: � ICONTRACTOR EMAIL; <br /> CONTRACTOR LICENSE#(REQUIRED): OIN CITY OF EVERETT BUSINESS LICENSE#(REcitil m)! <br /> PRIMARY CONTACT: ❑OWNER WONTRACTOR ❑OTHER(Please Speclfy) <br /> C NTACT NAME; CONTACT PHONE- Lia a <br /> LIZh <br /> -, CM km&M. CONTACT EMAIL: ' <br /> Existing Use of Building: Contract Price of Work:$ `V <br /> Proposed Use of 13ulidln : Heat Source: Toes ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR Attached ❑Du lex ❑Mull-Family-#of Units: ❑Commerclal ❑Induslrlai <br /> Type of Project: ❑New Tddltion MRemodel ❑Re air ❑T.I. ❑SI n ❑Sprinkler ❑Demolition ❑Chen a of use <br /> DESCRIPTION OF WORK; <br /> Tr6z "Xit LQ§ Luttolz <br /> ASSOCIATED BUILDING PERMIT# If applicable); <br /> ` "'���tl' `NI ;N fiMIT,APPLIQAT,ION' ',0L9MBiNG:-PLa#tr41T APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New XAddn --Alteration _Repair <br /> #of L/st of Fixtures #ofList of Fixtures' #of mat o/Fixtures 00 <br /> Fixtures Fixtures Fixtures Flxtw+es LisI ofFlxtures <br /> AIC–Alr Handling Units Heat Pump Tollet Backflow Preventer Inside Bldg) <br /> Forced Air 5 stemB Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory Wash Basin DrInking Fountain <br /> Water Heater Refrl eratlon Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tre <br /> Gas Range Ducting DIShwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood eater Other: <br /> Exhaust Fan Sink. (Service/Bar/Mop/etc. Other; <br /> Number of Heads <br /> ACKNOWLEDGEMENT.,f have reviewed this app/!ballon and confirm the Information contained herein is true and correct. Work done pursuant fo this permit must comply with <br /> Current fvdeia/,state,and local law.The granting of a permit only author/res approved work and no deviations therefrom.DeNaflons must first be authorized in writing from the <br /> Aulid/ng Oflicf$/before being authorized under any olrcumetance.I am(he owner,or I em authorized by the owner of this property to perform the work for which application is made, <br /> and i comply with the State Contractors Law 18.27 RCW and 296,200A WAC. <br /> City of Everett Official Use only <br /> I r � <br /> Le PERMIT <br /> «... <br /> Owner/Authorized Agent Signature ate <br /> (Revised 70/17./2015) <br />