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02/29/2016 MON 12: 27 FAX 4252521666 CM Heating U002/003 <br /> ! PERMIT APPLICATIOO <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 11 (P)425-267-8810 1 FAX 426-257-8857 I(E)everstteps@everettwo,gov I www.everettwa.gov/pernits <br /> ••ij:-'µlei \Y�. J 4: 5..' f !. <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX <br /> LEGAL for new conetructlon: Short Plat/subdlvlslon Lot No, (attach copy of long legal descrlptlon) <br /> ,CONTACT INIFORMATION. <br /> OWNER NAME: TENANT NAME(H Commerclal); <br /> OWNER MAILING ADDRESS: STREET rr \\ <br /> Ciro W eTATE z�P <br /> -22 OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (�'� <br /> CONTRACTOR ADDRESS: STRIMT oa <br /> Ctrl STATE <br /> CONTRACTOR PHONE: ZI d CONTRACTOR EMAIL; I ► nOC41OL2atuco- <br /> CONTRACTOR LICLNSE#(RL:QUIlRED):C -7-�0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CQ <br /> PRIMARY CONTACT: ❑ OWNER ONTRAC70R ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 1 <br /> CONTACT EMAIL: <br /> RUILOII!#G'PERMIT AppI,IC'ATION <br /> Existln Use of Bulldln Contract Price of Work: $ <br /> Proposed Use of Bulldln : Heat Source: Gas ❑Electric ❑Other <br /> Bulldln Type: ❑SFR-Detached FR-Attached ❑pu lex C Multi-Famll -#of Units: C]Cornmercial ❑Industrial <br /> T e of Pro ect: ❑New Addition ❑Remodel ❑Re air ❑T.I. ❑Sin CIS rinkler ❑Demaiition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> AlS IATED BUILDING PERMITIfcablB� <br /> ;MEC ` dl�lCAlk-'FT-IiMIT'APP,LIGATION '; <br /> PLOMBING,PERMIT APPLICATION. <br /> Typo of Project: _New ` Addn ya Alteration _Repair Type of Project; _Now —Addti Alteration epalr <br /> of N of <br /> Fixtures List of Fixturoa Fixtures List of Fixtures Fixtures#°f Ll9t of Fixtures #°f Fixtures Lisl of Fixtures <br /> A/C-Alr HandlIng Units Heat Pump Tollot Backflow Proventer Inside Bid <br /> Forcod Air Systems Unit Heater Bathtub Urinal <br /> pas PIPInq Boller Lavatory(Wash Beeln) Drinking Fountaln <br /> Water Heater Refrl oration Shower Floor Drain <br /> Gas Flre lace IWQQd Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range DucflnQ Dlshwasher Roof Drains <br /> Clothes Dryer Hooku e Other; Clothes Washer Madlcal Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other: <br /> ,�:`,';;SPRINKLEWI SUP ,RES'9ION'SYSTEM i' <br /> Number of Heade <br /> ACKNOWLEDGEMEN7".I neve reviewed this application and confirm the Information contained hereln Is true Ond correct, Work done pursuant to this permff must comply with <br /> current federal,state,and focal law. The granting of a permit only aw hor/zes approved work and no deviations Iharefrom.Deviations must(Irst be authorlrad in writing from the <br /> Building Offlclal before being authalzed under any clreumatenca. I am the owner,or I am authorized by the owner of thlS property to perform the work for which oppllcatfon Is mado, <br /> and I comply with the State Contractors Lew IR27 RCW and 206.40A WAC. <br /> City of Everett Official Use Only <br /> 77PERMIT# n � 0) <br /> Owner/Authorized Agent Signature bate (Revised 10/1212075) <br />