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