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07/01/2016 FRI 7: 45 FAX 425 252 1666 CM Heating U002/002 <br /> PERMIT APPLICATIONV'RINKLERBUILDING ECHANICAL / PLUMBING / SIG / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)426-257.8810 FAX 425-257.8867 1(E)everettepe(Meverettwa,gov I mm.evereltwo.gov/parmits <br /> aM�'�i;,o;�,`I� �a� ^IMn.�.'Q. ;1���s `°''' '' ' ''P�. ,� '��"� ,�;I�M�Q .M�!►�'��il�� <br /> PROJECT SITE ADDRESS: l PROPERTY TAX#.- <br /> LEGAL <br /> :LEGAL For now constructloh! Short Plat/subdlvlelon Lot No, (attach copy of Ione legal descrlptlon) <br /> •."R' � �ti��? hA�li'IC�N <br /> OWNER NAME; TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS; aTResT (p lJ <br /> CITY STATE IIP <br /> OWNER PHONE: a OWNER EMAIL! <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS! STREET <br /> CITY <br /> STATE L ZIP <br /> CONTRACTOR PHONE: CONTRACTOR RMAIL-viangd to <br /> .0 <br /> CONTRACTOR LICENSE#(REQUIRED) ��ln CITY OF EVERETT BU81NE88 LICENSE#(REQUIRED): <br /> PRIMARY CONTACT! ❑ OWNER WONTRACTOR M OTHER(Please Specify) <br /> CONTACT NAME: - CONTACT PHONE: <br /> CONTACT cjA-n <br /> 777 <br /> ExIatIng Use of Bulldln : lContract Prlee of Work: $ <br /> Proposed Use of Building: Hutt Source: 40aa ❑Electrlc 00ther <br /> Bulldln Typo: 17ISFR-Detached C78FR.Attaohod ❑Duplex 0Multl-Famll -#of Units: ❑Commerclal ❑Industrial <br /> T e of Pro ect: ❑Now ❑Addition CRRemgdBI MRe alr ❑T,I ❑SI n ❑S rinkier ❑Demolition ❑Chen a of Use <br /> DESCRIPTION OF WORK; I, <br /> ASSOCIATED BUILDING PERMIT# If appllcaw��v <br /> onowyca <br /> Typo of Project; _New _ Addn ,Alteration _Repair Type of Project: Now --1ddn _Alteration Rapalr <br /> #of Llst of F/xfuroe o #of #of <br /> Fixtures Fixtures Llat of Flxturetl Fixtures Llaf of Flxfuras Fixtures List OF Fixtures <br /> aridll <br /> A/C—Air HHeat Pum ackflow Preventor Inside gid <br /> mUnits <br /> Forced Air; <br /> Unit Heater Bath uh Urinal <br /> Gas PT-T-9 061ler Lava o Wash I3aslnDrinking Fountain <br /> Water Heater Refrl 'Shower Floor Draln <br /> Gas Fireplace Wood Stove Kitchen Sink&Dls oselGrease Trap <br /> Gas Reno OuctIng Dishwasher Roof Draina <br /> Clothes Dryer Hookups Other: Clothes-washer Medlcal Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink (Service/Dar/Mop/etc. Other: <br /> Number OT Heacls <br /> ACKNOWLEDGEMENT:I have reviewed this appiloaUon and confirm the lrlformatlon contained t)6min is true and correct, Work done pursuant to this permit must comply with <br /> current federal,state,and local law. Thu granting of a permit only outhorizas approved work end no deviations tharafrom_Davieflons must fist be authorized In writing from the <br /> 130ding Official before being authodzad undar any olroufnarence.I em the own®r,or I am author/zed by the owoor of thl3 property to perform the work for which oppiiceHon Is Made, <br /> and)comply with Ihu State Controctors Lew 18.27 ACW end 296.200A WA c. <br /> City of Everett QTc/a/Use Only <br /> - PER IT# 1 <br /> Owner/Authorized Agent Signature Date (Revised 5/20 2096 <br />