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05/03/2016 TUE 11: 09 FAX 4252521666 CM Heating U002/004 <br /> • PERMIT APPLICATIO10 <br /> BUILDING I MECHANICAL I PLUMBING / SiGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)426.257-8610 1 FAX 426.257-8867 1(E)everettsps!Peverettwa.gov I www.everettwa.gov/permlts <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ROPERTY TAX#: <br /> LEGAL,for new conatruclien: Short Plat/subdivlslon Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS; aG�r <br /> ern' STATE ZIP <br /> OWNER PHONE: 1 OWNER EMAILA <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET LA � C-J0C,---1) <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUI♦ZED): CITY OF EVERETT HUSINFSS LICENSE#(kEQU112Eb): <br /> PRIMARY CONTACT: ❑ OWNER NTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAM � CONTACT PHONE., r 0 56Z) <br /> n—�/�i' CONTACT EMAIL; <br /> OUILDINO PERIVITr.,APPLIC;I` IoN. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Fleat Source: s ❑Electric ❑Other <br /> Bulldln Type: ❑SFR-Detached FR-Attached ©Du lex [:1Multi-Fami1 -#of nits; ❑Commercial Qlndustrial <br /> TXpp of Project: ❑New ZddltloA ❑Remodel ❑Re air ❑T.l. ❑SI n []Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WOR <br /> sots <br /> ASSOCIATED BUILDING PERMIT#A If applicable): <br /> MECHANICAL PERMIT APPLICATION' PL00131ka PEitMIT:APPLICATION <br /> Type of Project: Now _ Addn _Alteration Repair Typo of Project; _New _Addn _Alteration _Repair <br /> #of Lisr of Fixtures <br /> Fixtures Ftxfu os L/st of Fixtures F/xtu es List of Fixtures Fixtures L/st of Fixtures <br /> A/C—Air HandlIng Units Heat Furnp Toilet Backflow Preventer Inside Bld <br /> Forced Air 5 ®tams Unit Heater Bathtub Urinal <br /> Gas Pi in Boller i-avato Wash Basin Drinking Fountain <br /> Water Heater Refrigeration shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Greass Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran a Hood Water Heater Other: <br /> Exhaust Fan Slink Servlce/Bar/Mo /etc. Other: <br /> SPRINKLER/ SUPPRESSION SYS'T'EM,' <br /> Num er o?Me'al s <br /> ACKNOWLFOGEMFNTr 1 have roviewnd this appilCetlon and confirm the informa(lon Contelnad herein Is true and Correct Work dons pursuant to this permit mus(comply with <br /> Current federal,state, and focal law, The grunfinp of a permit only authorizes approved work and no deviat/ons therefrom.Deviations must first be authorized in writing from the <br /> Building OfAclel before being authorized under any circumstance.i am the owner,or t am authorizad by the owner of this proparry to perform the work for which application is made, <br /> and I comply with the State Gorr ac( a Law 10-27 RCW and 296.200A WAC. <br /> City of Everett OKlclaf Use Only <br /> / I PERMIT# <br /> Ownar/Authorizod Agent 8ldnature Date (Revised 90/92/ OifsJ <br />