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07/15/2016 FRI 14: 48 FAX 425 252 1666 CM Heating 0002/002 <br /> ! PERMIT APPLICATIOA <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OOL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-0610 1 FAX 425-257.6657 I (E)everetteps@everettwa.gov I www.everettwa,gov/permits. <br /> BIuA o� � 4 ,'I��'i?nI leta>4�I plit? $� $ITIS IN�Q�i O <br /> PROJECT SITE ADDRESS: aL Vj I PROPERTY TAX#: <br /> LEGAL for new constrUotlon, Short Plat/subdivlslon Lot No. (attach copy of long legal deocrlpticn) <br /> ONTAOT INFQRMATION <br /> OWNER NAME; �-� TENANT NAME(If Comm1a^rclal): <br /> OWNER MAILING ADDRESS; STREET <br /> GIN STATE Uo ZIP <br /> OWNER PHONE: ac) OWNER EMAIL; <br /> CONTRACTOR NAMEi <br /> CONTRACTOR ADDRESS; STREET I LJ <br /> GIT' STATE ZIP <br /> CONTRACTOR PHONE; CONTaACTOR I~MAIL: KQ&l <br /> CONTRACTOR LICENSE#(REQUIRED) ��1( Yl CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER(please Speolfy) <br /> CONTACT NAME: �} -, CONTACT PHONE: <br /> " ' 1 1CONTACT EMAIL: <br /> ;k.. <br /> Existing Use of Dulldin : lContract Price of Work: 3 <br /> Proposed Use of Sulldln Heat Source: as El Electric ❑Other <br /> Building Type; CISFR-Detached CISFR-Attached ❑Du lex ❑MUltl-Fami[ -#ofUnits: ❑Commercial ❑industrial <br /> T e of Proect: ❑Naw ITAddltlon MR®modal L]Re alr ❑T.I. ❑Sin ❑5 rinkler MDamolltion ❑Chen o of Use <br /> DESCRIPTION OF WORK: <br /> ?I-Cv cum - - -- <br /> ASSOCIATED BUILDING PERMIT# If a Ilcaple : <br /> is FIFFRI1.1; 795"R 7. <br /> Type of Project: _Now _ Addn ,r„-Altoratlon _Repair Type of Project: _New _Addn —Alteration _Repair <br /> of <br /> Fl#utas Lis of Plxrures Flrtu 1 Lla!of Fixtures #of List of Fixtures #of List of Fixtures <br /> Plxfares Flxfu»s <br /> A/C—Air Handling UnIts Heat Pump Tollet Backflow Preventer(Inside Bldg) <br /> Forced Air S sterna nlf eater bathtub Urinal <br /> Gas Piping o ler Lavatory ash sail= Winking Fountain <br /> Water Heater e r oration Shower loot Draln <br /> Gas Flre lace Wood S ova kitchen Sink& Disposal Grease Trap <br /> Gas Range DuctIng asher Roof Drains <br /> Clothes Dryer Hookups ter: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink (Service/Bar/Mop/etc. Other: <br /> um er of HeoidiF <br /> ACKNOWLEDGEMENT.I have revlewed Jhfs appllceflon and confirm Me Information confalnod heroin Is true and correct. Work done pursuant to this permJ1 must comply with <br /> current federal,efate,and local law. The,granting ole permit only suthorrzes approved work and no deviations therefrom.Devlallons must first be authorized to wri0rig from the <br /> Bullding Official before being euthorlzed under any c/rcumstenoe. I am the owner,or I em authorized by the owner or this properly fo perform the work for which eppliceflon is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of EvereIf Official'Use Only <br /> PE;R"T <br /> Ow arlAUthorIzed Agent Slgnature Date (Revised 5/20/2016 <br />