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06/22/2016 WED 13: 27 FAX 425 252 1666 CM Heating 0005/006 <br /> PERMIT APPLICATI019 <br /> BUILDIN J01MEC HAN ICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SLPVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-0857 1(E)everettepaaeverettwa,gov I vw✓w,everattwa.gov/permIla <br /> �Ii<Itq k' Bahl `Pit r�l> � Q E T 01TOMFORRATI, <br /> PROJECT SITE ADDRESS; PROPERTY TAX X: <br /> LEGAL for naw conatructlan: Short Plat/aubdlvlslon Lot No, (attach copy or lone leual deacrlptlon) <br /> OWNER NAME: h TENANT NAME(If Commerclol): <br /> OWNER MAILING ADDRESS: STRFFT <br /> ciTr STATE ztP S <br /> OWNER PHONE: �- ZS OWNER EMAIL; <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STR!E7 <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE; 41n 2r�nM <br /> CONTRACTOR EMAIL: � Lim <br /> CONTRACTOR LICENSE#(REQUIRED) -1­1n CITY OF EVERETT BUBINE88 LICENSE#(REQUIRED); <br /> PRIMARY CONTACT: El OWNER VENTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT(MAIL: I fig, Cel <br /> ,.i'/:n 11 ¢t� '.i ka, ,'�; :rtidP`i, ,,� ,� .SIR. .�1 •r; 77 <br /> ExIstInR Use of Bulldln Contract Price of W Tk; $ �® <br /> Proposed Use of Bulldln ! Heat Source: 016as ❑Electric ❑Other <br /> Buildin e: ❑SFR-Detached R-Attached ❑Du lex ❑Multi-Femll -#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New MAddltlon ORemodel ❑Re alr MT.I. ❑SI n ❑S rinklsr 00ernolltlon ❑Chan a of Use <br /> DESCRIPTION OOF�W^O IRK: 8as <br /> ASSOCIATED BUILDING PERMIT# If a Ilcpble <br /> Type of Project: _NOW _ Addn _.Alteration Repair Type of Project: Now T — <br /> Addn Alteratloa _Repalr <br /> #of L/s!of Flxtur®a of #of <br /> Fixlurea F/xfuret List'of Fixtures Fixtures Llst of Fixtures °f Fixtures List of Fixtures <br /> A/C-Air Handl n Unite eat Pump Toilet Backflow Preventer Inside Bldg) <br /> Forced Air systems Unit Heater 5athtob Urinal <br /> Gas Piping 01®r l.avato Wash as n) brinklng Fountain <br /> Water Heatera Refrigeration- ShoWer Floor Drain <br /> aas Fire lace TV00d Stove KItchen Vnk&Disposal Grease Ira <br /> Cas Ran ® DuctinDishwasher Hoof Drains <br /> Clothes D er Hooku a Other; Clothes Washer Medical Gas <br /> Range Hood Water Heater <br /> Other: <br /> Exhaust Fan Sink (Service/Bar/Mop/etc. Other: <br /> um or of Heada �q E - <br /> ACKNOWt_j�G'EMENT:I have reviewed fhls appllcallal and confirm rhe Information contained herein i9 true and correct. Work done pursuant to this permit must compty with <br /> Current federal,State,and local law. The granting ora permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br /> 6ullding Official before being eurhorlzed cinder any circumstance.I am the owner,or 1 em aulhorizad by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Low 18.27 RCW and 298.200A WAC. <br /> I _ Cityof Evarett Official Ufse�Only <br /> X-11 �JZ-Zh <br /> t-c PERMIT <br /> Owner/Authorized Agent 9lgnatur0 Date (Revise d 0001t9 <br />