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03/21/2016 MON 12: 49 FAX 4252521666 CM Heating U002/003 <br /> 0 PERMIT APPLICATIO10 <br /> BUILDING / MECHANICAL / PLUMBING I SIGN i SPRINKLER/ DEMOLITION <br /> CITY Or EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-6810 I FAX 426-257-8857 1(E)everetlepeQeverettwe.gov I w w,everettwa,gov/permits <br /> :"Y�rr:;);� `�;. ., •>�� ;� �• :,,,, PROJECT SiTE INFORMATION <br /> PROJECT SITE ADDRESS: i 'T7) PROPERTY TAX#: <br /> LEGAL for new conetructlon: Short Platleubdlvlelon Lot No,— (attach copy of long legal dascrlptlon) <br /> :�"CONT4CT INPbRMATION' . <br /> OWNER NAME: �- TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS; STREET falZ <br /> o17Y $TATE W71) ZIP <br /> OWNER PHONE: dty906 OWNER EMAIL: <br /> CONTRACTOR NAMEI <br /> CONTRACTOR ADDRESS: STREET ''''�� <br /> CITY 37ATE ZIP '—Z-',rr��J <br /> CONTRACTOR PHONE: C..OIINTRACTOR EMAIL; CO <br /> CONTRACTOR LICENSE#(REQUIRED): �� C�1V CITY OF EVERETT BUSINE58 LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> Lrh CKCONTACT EMAIL: CIA) Cbrkl <br /> 11130XLPJN,Q PERMIT APPLICATION <br /> Exlatlng Use of Building: Contract Price of Work: S .ZJ <br /> Proposed Use of Bulldln Heat Source: Gas ❑Electric ❑other <br /> Building e: ❑SFR-Dete had SFR-Attached ❑Du lex ❑Multi-FamIi -#of Units; ❑Commercial ❑industrial <br /> Type of Project: ❑New Addition ❑Remodel ❑Repair [IT.]. []Sign ❑S rinkler ❑Demollhon ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ASSPOCIAT D BUILDING 4eMT# If a Ilcable <br /> tl "trMCC1(iAN�C.AL P.ERMiT`QPP.,LICATION . PLUM8IN0 PERM T.APPLICATION <br /> Type of ProJsct: _New Addn --j4lteration _Repair Type of Project; _New __Adcin _Alteration _Repair <br /> of Fixtures Llst of Fixtures F! of g Llst of Fixtures #of List of Fixture$ #of List of Flxturos <br /> Fixtures Flxturos <br /> A/C—Air Handling Units Hest Pump Toilet Backflow Preventer Inside Bldg) <br /> Forced Air Systema Unit Heater Bathtub Urinal <br /> Gas Piping Boller Lavatory Wash Basin Drinking Fountain <br /> Water Heater Refrl eratlon Shower Floor Drain <br /> Gas Flre lace I Wood Stove 1KItchen Slnk& Disposal Grease Tra <br /> Gas Range DuctIng ID10washer Roof Drains <br /> Clothe® Dryer Hookups Other: Clolhes Washer Medical Gas <br /> REn a Hood Water Heater Other: <br /> Exhaust Fan Sink Servlce/Bar/Mo /etc. Other: <br /> "'�;�<i'r:.$1�,i�INKL;'11�';�?SUPPRESSIdN'SYSTEM� <br /> [Number of Head,5 <br /> ACi(NOWLEDGJ=M>=NT:i have reviewed this epplication and cornflrm the Information contalned herein is true and correct. Work done pursuanl to(Pis permit must comply with <br /> current federal,state,end local law. The granting of a permit only authorises approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br /> Building Official before being authorized under ony circumstance. I em the owner,or I em authofized by the owner of this property to perform the work for which appllcation Is mado, <br /> and 1 comply with the State Contractors Law 10.27 RCW and 296.200A WAC. <br /> City Oft"veret'pff/cial Use Only <br /> PERI <br /> VAi 3 �a)l .�,� � Q <br /> OwnerlAuthorized Agent Signature bala (Revised 1 2 015) `/Y <br />