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08/12/2016 FRI 8: 44 FAX 425 252 1666 CM Heating U014/031 <br /> • PERMIT APPLICATIOS <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVLRETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT, WA 88201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everettepsQevereltwa,gov I www.everBttwa.pov/permlts <br /> (BII��.gw;Blac ,llnk"OnI ,Please PR0J1EPT SI*61NFORAtION. <br /> PROJECT SITE ADDRESS: `,v RTY TAX!/: <br /> LEGAL for new construction' Short Platleubdlvlslon Lot No, e, J(.tf.,.hrCpyoflollgiecialdoscriptiori) <br /> DONT CT"IN'p, RMAT16N <br /> OWNER NAME; TENANT NAME If Commerclal); <br /> OWNER MAILING ADDRESS: sTREer 1 �} <br /> CITY STATE ZIP <br /> OWNER PHONE: � �j QQ OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: sTaseT <br /> CITY STATE (Aft <br /> CONTRACTOR PHONE: ` (} CONTRACTOR EMAIL: d <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Speclfy) <br /> CONTACT NA/M�ErCONTACT PHONE: <br /> U CONTACT EMAIL; 011 <br /> ;. ;BUILQII�Iti'PERMIT.APPL'''IO�i,!"I'rON''� <br /> Existing Use of Building: Contract Prlco of Work: $ (� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑EleclriC ❑Other <br /> Bulldin Type:- ❑SFR-Detached 1151713-Attached ❑Du lex uiti-Famil 4 of Units: -;h ❑Commerclal ❑Industrial <br /> IyEtof Pro oct: ❑New Addition ❑Remodel Okepair T.I. ❑SI n ❑S rinkler []Demolition ❑Chan a of use <br /> DESCRIPTION OF WORK: <br /> M(4al I doub) 0,agylp Cn s <br /> ASSOCIATRO BUILDING PERMIT# If applicable): <br /> 'MECHANICAL OJOIV MAPPL'r¢A'now 7_ '77 <br /> I'LUMBLNI(3'PIERMIT APPLICATION <br /> Type of Project: _Now _ Addn _Alteratlon _Repair Type Of Prg)vcti Now Addn _Alteration Repair <br /> 9 of <br /> Fixtures List of Fixtures F/xlures List of Fixtures #of List of Flxlurea p of List of F/Xtures <br /> -Fixtures Flxture� <br /> A/C—Air HandlingUnits Heat Pump Toliet Backflow Preventer Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas_P!ping Boller Lavatory Wash Basin Drinking Fountain <br /> Water Heater Refricieratlon Shower Floor Drain <br /> Oas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer <br /> Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink (Service/Dar/Mop/etc. Other: <br /> SPRINKLER/'$'UPPRPSS10N SY$'T'eM <br /> Number Or at s <br /> ACKNOWLEDGEMENT:I have Wlawed thla application and confirm the informatlan aonialned heratn Is true and correct. Work dorso pursuant to this pormlt must comply with <br /> current(ederal,state, and local law, The granting of a permit only authorizes approved work and no devlatlons therefrom,Deviations must first be outho•tzed In welting from the <br /> 9u(l01119 Oftial before being authorized under any circumsionce./am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contrectors Law f0.27 RCW and 29E.200A WAC, <br /> M City of Everett ONlclal Use Only <br /> 1 <br /> PER IT O <br /> rrfa//( 03 <br /> Owner/Authorized Agent Slgna lire Da (Revised 20 096 <br />