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12/09/2016 THU 7: 09 FAX 425 252 1666 CM Heating U0O2/002 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> 1 nd CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> ` (P)425-257.8810 I FAX 425-257-8857 I (E)overeff I www.everettw0.gov/permIts <br /> .(Blare.a'l 'BI0i °.I0(.cwiIy PIaN .SITE,110.0 Ti: ,. , <br /> PROJECT SITE ADDRESS; Le I 0 We."- J112--Q___, PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlsubdlvlglon Lot No. (attach copy of long legal descrlptIon) <br /> '':;li •;,..':: CONTAct INFOR l,ATIoN , - <br /> • <br /> OWNER NAME: ...i , L Ina r 0_ TENANT NAME If Commercial); <br /> OWNER MAILING ADDRESS: sTttEer 1 (i 1b � �� <br /> CITY `�J—`2"1 STATE fCr TITS 9 1 <br /> OWNER PHONE: Lt' s 34c7 --(3(?) OWNER EMAIL: <br /> CONTRACTOR NAME" in 0 .. <br /> CONTRACTOR ADDRESS; STREeTaezzLau2:273_,,1 1";?-4 <br /> CITY V`STATE ZIP Cie20 <br /> CONTRACTOR PHONE, <br /> Li <br /> D� p`GC( CONTRACTOR EMAIL: rL� 'F� 7C-4 /t�2,�"j„n�r C }m <br /> CONTRACTOR LICENSE#(REQUIRED): 0-7QUIRED):1 .(76/ <br /> /fir { CITY OF EVERETT BUSINESS LICENSE#(RE <br /> PRIMARY CONTACT: II OWNER T ONTRACTOR 0 OTHER Please Specify) <br /> CONTACT NAME; ' . <br /> CONTACT PHONE: 4a5 aOIN-1 n � A <br /> CONTACT EMAIL: 9 )�{ • cr <br /> . -- - ,_'` . ,...�'• 'BUi DJN�G'PCR MIX PLICATI•.N. 1 , ,,,,ti ., , .. <br /> Existing Use of Building; <br /> Contract Price of Work; $ 1O0‹) <br /> Pro <br /> ose <br /> . p d Use of Building: <br /> Heat Source: Kas ❑Electric ❑Other <br /> Building Type: 2FR:Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommerclel ❑Industrial <br /> T •e of Pro act: ❑New ❑Addition ❑Remodel ❑Re•eIr 07,1, ❑Si•n ❑S.rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> q-\_12,0,cL. Le__- H-- <br /> ASSOCIATED BUILDING PERMIT# It;f a Ilceble): <br /> 041- OHAN�14'Z#I" T1� L'1��1 > -• <br /> ;;;. .,. � 1>RL���INC� P�I�M1111��'pAR,Ri•I�QTIOF�' '� �", <br /> _ ' <br /> Type of Project: _Naw _ Addn Alteration �Repair Type of Project: New Addn _Alteration Repair <br /> #o/ List of F/xturer #of #of #Of — <br /> Fixtures Flxturab List of FIXturea List of Fixtures Llst of Fixtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units Heat pumpBackflow Preventer(Inside BId ) <br /> Toilet 9 <br /> Forced Air SystemeBathtub Urinal <br /> y Unit Heater <br /> Gas Piping _ Boiler Lavatory(Wash Basin) Drinkin. Fountain ^ <br /> Water Heater Refrl.eratlon Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> w <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 /> '.''f:;,,,!1; ..PFRINK 1 1k?Cr4i pP E3S19N"$YST, .00*':''.:': <br /> Number of Heads <br /> 4CKNOWLEDOEMENT;i have reviewed this application and confirm the Informetlon contained herein is true end correct. Work done pursuant to this permit must comply with <br /> ;urrent federal,slats,end 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 wider any circumstance,i am the owner, or I em authorized by the owner of this properly to perform the work for which application Is made, <br /> !fid I comply with the State Contractors Law 18.27 RCW and 298,200A WAC. <br /> / /� City of Fvsreft Ofic/et Use Only <br /> v�� i�f ).�2X I L J r PERMIT c c <br /> D n r/Authorlaed Agent Signature �f' a ` O` �.��� <br /> bate (Revised 9/2312016 <br />