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06/17/2016 FRI 14: 00 FAX 425 252 1666 CM Heating 1L002/003 <br /> PERMIT APPLICATION* <br /> BUILDINGOECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everettepa®everettwa.gov I vvww.everattwe.gov/permlta <br /> PROJECT SITE ADDRESS; Bah2& PERTY TAX 4: <br /> LEGAL for now conatruotlon: Short Platlaubdlvlslon yy `may] Lot No. (attach copy of long legal descriptlon) <br /> 77 <br /> OWNER NAME. 't` 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 <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL! <br /> CONTRACTOR LICENSE#(REQUIREp) �n CITY OF EVERETT BUSINESS LICENSE#(REQUIREd): <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR M OTHER(please Specify) <br /> CONTACT NAME: CONTACT PHONE; <br /> 1_ J► t CONTACT EMAIL; ' <br /> q 1 <br /> Exl9t1nq Use of Bulldln Contract Price of Wo k; $ <br /> Proposed Use of Building; Heat Source: Zdas lectrlc ❑Other <br /> Bulldln Type: ❑SFR-Detached R.Auached ❑Du lex LJMUltl-Famll -#of Units: ❑COMMarcial ❑Industrial <br /> T e of Proect: ❑New dltlon ❑Remodel GRe air ❑T.I. ❑SI n MS rinkler ❑Demolition []Chana of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATEp BUILDING PERMIT# If appllc0la : <br /> � <br /> ,v` "Roma � � NOT <br /> OA <br /> a <br /> Type of Project: _New Addn Alteretlon _RepAlr Type of Projeat: _Now �ddn _Alteration Repair <br /> #of List of Fixtures � oat or <br /> Fixtures lrlxfur'11s Lilt of Fixtured Fixtures Llaf of Fixtures F/xtur s List of FhrtuYee <br /> A/C—Air iHandlln Units HOW-P-Llinp Toilet Backflow Preventer Inslde Bldg) <br /> Forced Air Systems Unit Heater Bythl.Llb Urinal <br /> Oa8 piping o or ovate Wesh Basln) tJrinklng Fountain <br /> Water Heater e r Brat on Shower Floor Dr21n <br /> Gas Fireplace Wood Stove Kitchen Sink&Dls oral Grease Trap <br /> Gas Range uctin Dishwasher Roof Drains <br /> Clothos D er Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan 9Ink Servlce/ ar/Mo /etc. Other; <br /> um er o ea e <br /> ACKNOWLEDaEAAIENT:I haus ravlewacf Ihle epp1lcAfion and confirm[ha informet/on contained herein Is true and correct. Work dorso pursuant to tills permit must comply with <br /> current federal,state,and focal taw. The g/gnHng of a permit only author/zes approved work a�d no davletlon®therefrom.Deviations must first be authorized In writing from the <br /> Building official baro re being euthoNred under any olrounlafance.t em the owner,or f em eufnorlsad by the owner of this property to perform the work for which application Is made, <br /> and I comply with the State Contractors Law 18,2717CW end 29®.200A WAC. <br /> City or Everett omalal Lisa Only <br /> PERMIT# i— <br /> I <br /> awns/Authorlzod A®ent 481o.C.t.r. pate (Revised 612012M <br />