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12/01/2016 THU 5: 30 FAX 425 252 1666 CM Heating L002/003 <br /> PERMIT APPLICATION <br /> / .� BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> ‘,4081 -1,. <br /> teCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425.257-8810 I FAX 426-257-6857 I(E)everettepBQeverettwa.gov I www.evereftwa,gov/perrnits <br /> SBIU,O 0r,','Rltac 'IrIk..O'n1y;.RIO$c)'.. '. PRIOJE0,8IT.E'INF,IQRIMIIATIaN :!',, ;,.' ":1,::.V.'..•:'..:,'', -; ' ' <br /> PROJECT SITE ADDRESS; ‘ -CCP 2-1,ST Q)J e._ PROPERTY TAX#: <br /> LEGAL For new construction: Short Plat/subdivision Lot No. attach co <br /> `� ( copy of lona legal description) <br /> :.;;I ,., C'ON`t'I,�IT IN�O`RM ��ti1 'r, �',,.• ,, ' <br /> - <br /> OWNER NAME: `....L , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS; sTRet:r 0 I,,. (p 21 S <br /> CITY ' <br /> STATE LA...-341 ZIP 0 7k <br /> OWNER PHONE: `7�0 t OWNER EMAIL: VV «11 <br /> CONTRACTOR NAME: _CAM if\Q A.1 / <br /> CONTRACTOR ADDRESS: STREET ? le p ; , 11. _ f <br /> CITY �� t> \• 8TATE , zlP C -Zc <br /> SGT' ( <br /> CONTRACTOR PHONE: SOS pCONTRACTOR EMAIL: rkLe-Aeckt tDC4. -17 <br /> CONTRACTOR LICENSE#(REQUIRED): TU44 I0 7 7cL v CITY OF EVERETT BUSINESS LICENSE#(REQUIRED l4,0 9 C) <br /> PRIMARY CONTACT; ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME; (`� CONTACT PHONE; uQt a 0 <br /> — <br /> CONTACT EMAIL: Y �� ��nM <br /> a <br /> ' Ul bIN 'P1 IT'A0A; 0A�I N ,, • <br /> Existing Use of Building: ° <br /> Contract PrIca��off Work: $ .4.-_ � <br /> Proposed Use of Building; Heat Source: irC7flas ❑Electric ❑Other <br /> Building T •e• Wil:,R-Detached DSFR-Attached ❑Duslex ❑Multi-Famll -#of Units: <br /> ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ©Change of Use <br /> DESCRIPTION OF WORK: _ 1- <br /> oy <br /> 4SSOCIATED BUILDING PERMIT# if a Piicabie : <br /> I11116A * MMjT';oP14ATi�.` !:r r' Pt,VMbI oa QpppM !t `orJay <br /> ryp•of Project: _NuW _ Addn _Alteration _Repair Type of Project: New _Addn �Iteratloh <br /> RapelrM o/ <br /> List of Fixtures #°f List of Fixtures #°rit <br /> Fix Fixtures Fixtures List p;�Flxluras of List of Fixtures <br /> Fixtures <br /> 'A/C–Air Handling Units Heat Pump <br /> Toilet Backflow Preventer <br /> ) Forced Air Systems Unit Heater (Inside Bldg)Bathtub Urinal <br /> Gas piing Boller Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower <br /> Gas Fireplace r Wood StoveFloor Drain <br /> Range Kitchen Sink&Disposal Grease Trap <br /> Gas Ran a Clothes Dryer Hookups DuctOthing Dishwasher Roof Drains <br /> Range Hood Clothes Washer Medical Gas <br /> Exhaust Fan <br /> _ Water Heater Other: <br /> _ Sink 4Service/Bar/Mop/etc.) Other: <br /> k$aI I1$l i�rt' I:rI 4,4 i,QN:IOYSt, I�':'i',' — <br /> 1?/'I+Num6er of Heade <br /> CKNOWLEDOEMENT,I have reviewed this application and confirm the information contained herein is true and correct. Work--.. <br /> ork d❑onn.e pursuant to this permit must comply with <br /> rrrant 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 /> Lidding Official before being authorized under any circumstance. I am the owner, or I am authorized by The owner of this property to perform the work for which application Is made, <br /> 7d 1 comply with the State Contractors Law 78.27 RCW end 290.200A WAC <br /> City of Everett Ofticlei Use Only <br /> 1� � <br /> Date <br /> PEM <br /> E 2 - 002, <br /> 2.Z.thorizad Avant Signature 1) l G <br /> (Revised 9/23/2016) <br />