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04/11/2016 MON 16: 14 FAX 4252521666 CM Heating U002/003 <br /> PERMIT APPLICATIOIS <br /> BUILDING MECHANICAL / PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT, WA 96201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everettepaQeverettwa.gov I www,evereltwa.gov/permits <br /> PROJECT81TE INFORMATION.. <br /> PROJECT SITE ADDRESS: —10 <br /> /� PROPERTY TAX N: <br /> LEGAL for now constructlow Short Plstlsubdlvlelon Lot No (attaoh copy of long legal descrlptlon) <br /> CONTACt,INFORMATION " <br /> OWNER NAME: V n Lk L— TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS; STREET <br /> CITY STATE ZIP <br /> OWNER PHONE; OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS; STREET C <br /> 12 <br /> CITY STATE ZIP 26 f <br /> 51 CONTRACTOR PHONE: U CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE I#(REQUIRED): 1 CITY OF EVERETT BUSINESS LICENSE tf(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER %CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME- <br /> 'CONTACT <br /> CONTACT PHONE: <br /> ll CONTACT EMAIL: qpl (40�/'1/j <br /> •' '' "BI)ILDI'NG PERMIT APPLICATION' <br /> ExIGtIng Use of Building: Contract Price of Work; <br /> Proposed Use of Building: Heat Source: es ❑Electric ❑Other <br /> Bulldin Typo: USFR-DatachQ SFR-Attached ODu lex ❑Multi-Famll -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro oct: []Now dltlon ❑Remodel ❑Re air ❑T.f. []Sign ❑5 rinkler UDemolilion LJOhangig of Use <br /> DESCRIPT ON OF WO K; <br /> NO oxL, 6-iT'5 a-e-,o- <br /> LASSOCIATED BUILDING PERMIT# if a ticahlB : <br /> 11MCHkN1C41::p,1ERMIT-;AP.PLICATI,O,N, ;,` ' PLUM13IN(3iPEsRIVI1T;�pR411111LICdT1ON4 <br /> Type of Project: _Now Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixture. Lfwt of Fixtures Fixtures List of Fixtures #of Fixtures List of Fixtures #°f Fixtures Llst of Plx(ures <br /> A/C—Air Handling Units Heat PumE Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller Lavatory Wash Basin) Drinking Fountain <br /> Water Heater Refrl eratlon Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Slnk&Disposal I Grease Tra <br /> Gas Range Ducting Dishwasher Roof Drains <br /> lClothoisDryer Hookup Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan $Ink ServloolBar/Mo /etc. Other: <br /> SPRINKLER"'/SUP.PRQ$S,ION::SY,$XIVL:'`.' <br /> umber of Heade <br /> ACKNOWLEDGEMENT,-1 have rev/owed this application and confirm the information contained herein Is true and correct. Work done pursuant to this permit must comply with <br /> current seder&t, state,and/coal law. The prantlng of a permit only authorizer approvad work end no deviations therefrom,Deviations must first be authorizad In wrlttng from the <br /> Building Official before being authorizad tinder any Clrcumatance./am the owner,or I am authorized by the owner of this property to perform the work for which application Js made, <br /> and I comply with the State Contract 9 s Law 18.27 Wand 2 .200A WAG. <br /> City❑f Everett Official Use Only <br /> PERMIT# <br /> til � I i �•, I��7 —1 <br /> Owner/Authorized Agent Signature Data <br /> (Revised 10/12/2016) <br />