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03/03/2016 THU 12: 16 FAX 4252521666 CM Heating U002/004 (001F1E77 PERMIT APPLICATIO BUILDING I MECHANICAL / PLUMBING I SIGN / SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257.8810 I FAX 425.257-8857 I(E)everettepeQeverettwa.gov I www,everettwa.gov/permIte ' PROJECT SITE INFORMATION' PROJECT SITE ADDRESS;a/�X10 1 permoRcy ate PROPERTY TAX#LEGAL for new construction: ShortPlaattl/euhdlvvislon `• Lot No. (attach copy of long legal description) 'CONTACT INFORMATION OWNER NAME: J , - 4,0 i o �r--sy TENANT NAME(If Commercial): OWNER MAILING ADDR SS: sracET ,0 pc2() ' 'w1t(1/1.0 Re ()Ve, Vol CITY} �,�-'li OTATE Vo ZIP °I D ( OWNER PH0,0(o qaq ii�S D./ (OWNER EMAIL: CONTRACTOR NAME; Cr() T1 'Gn- , CONTRACTOR ADDRESS: STREET 11-05 BRO. t VI-- CITY ` STATE ZIP a_Q 1 CONTRACTOR PHONE: 5 aJQ 0 • CONTRACTOR EMAIL: i �.mac_ • � _._.� n •. _4 ado CONTRACTOR LICENSE#(REQUIRED):0I1:ear th g7 le (\( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1 •.CI 92) PRIMARY CONTACT: lip OWNER A CONTRACTOR 0 OTHER(Please Specify) f CONTACTppNAME: /� CONTACT PHONE: LZ -q O55O _L. ` � m N G- CONTACT EMAIL: �C(.�{,� aryl mow. �'1 aryl in BUILDING PERMIT APPLICATIOIH , Existing Use of Building: Contract Price of Work: $ C 11°50 • 0 O Proposed Use of Building: Heat Source: $Gas ❑Electric ❑Olher� Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units:_ ❑Commercial ❑industrlol Type of Project ❑New pAddltlon ❑Remodel ❑Repair DTI, ❑Sign ❑Sprinkler ❑Demoiltion ❑Change of Use DESCRIPTION OF WORK:n &_ . I n"` y rump 93 Qi—er I t ASSOCIATED BUILDING PERMIT#(if applicable): �/ '., MECHANIOAL PERMIT'APPLICATION ' ',PLUMBING PERMIT APPL$CATION Typo of Project: __New a_ Addn Alteration _Repair Type of Project; _New _Addn Alterctton _Repair y #or List Of Fixtures #of 0 of Fixtures Fixtures flat of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures NC—Air Handling Units 1 Heat Pump Toilet Backflow Preventer(inside Bldg) Forced Air 5/stems Unit Heater Bathtub Urinal W Gas Piping Boiler Lavatory(Wash Basin).. DrinkinQ Fountain Water HeaterRefrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc,) Other: ';. ,SPR)INICLER://SUPPRgSSION SYSTEM , Number of Heads - ACKNOWLEDGEMENT:I have reviewed this application end confirm the Information contained herein Is true and correct. Work done pursuant to this permit must comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the Building Official before being authorized under any circumstance.I em the owner,or I am authorized by the owner of this property to perforin the work for which application is made, and I comply With tha State Contractors Law 18,27 RCW and 296.200A WAC. City of Everett Official Use Only • e "a Ribir 3 . PERMIY{/ii'll itat —C61. i Owner/Authorized Agent Signature OatRevised 10/121201 ( B)