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09/28/2016 WED 14: 33 FAX 425 252 1666 CM Heating 0002/002 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-6810 i FAX 425-257-8857 1(E)everetteps@everettwrl,gov I www.averettwe,gov/perrnIts <br /> Rhuo.qlr Ulm'I( Ink ptSl p]tasste �RQJ�CT SITE INFOqMATlO.N <br /> PROJECT SITE ADDREgg; PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdlvfsion Loi No. (attacti Copy of long legal doevription) <br /> CQ,N`rACT IINIF01tMAIrION <br /> OWNER NAME: TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS; STREET <br /> –> <br /> Q rry STATE ZIP <br /> OWNER PHONE: �JQE OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STHFET (� <br /> CIN STATE YIP <br /> CONTRACTOR PWONE; CONTRACTOR EMAIL: } <br /> CONTRACTOR LICENSE#(REQUIRED):Cp{'� n CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: r CONTACT PHONE: a '^9 <br /> CONTACT EMAIL: (y1f 5 (01Y1 <br /> 1N P <br /> Existing Use of Building: Contract price of Work: 6 <br /> Pro osed Use of Bufldin Heat Source: Gas []Electric ❑Other <br /> Bulldln Typo: ETSFR-Detached ❑SFR-Attached ❑Du lex ❑Mull(-Family-#of Units; ❑Cornmerclal ❑Industrial <br /> T e of Pro act: ❑New ❑Addition ❑Remodel ❑Re alr ❑T.l. ❑Sin 05 rinklor ❑Demolltlon ❑Chan s of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED By�U,IS,�LDING PERMIT# If a llcable ; <br /> I <br /> "A )o <br /> 'r ' <br /> IVI:IT, T.. O <br /> Type of Project: _New Addt1 _Alteration Repair Type of Project; Now WAddn _Alteration <br /> —Repair <br /> # <br /> of List of Fixtures #°r .--.. <br /> Fixtureof FlXfure List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer Inside Bldg) <br /> f=orced Air S stems 7nit Heater Bathtub Urinal <br /> Gas.PIpLn.Q Boller Lavatory Wash Basin Drinkln Fountain <br /> Water Heater Refr! eratlon 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 /> Ran a Hood Water Heater Other: <br /> Exhauat Fart Slnk (Service/bar/Mop/etc. Other: <br /> Number of Heads <br /> ACKNOWLEDGEMENT;I have rnvlAwed this appllootlon and confirm the hiformation contelned herein Is true and correct. Work done pursuant to this psrmll must comply wlth <br /> :arrant federal,sta(e, and local law. The grenting of a permit only outharizes approved work end no devlaticns therefrom.Devlations must first be authorized M writing from the <br /> 3ultdiny Offlclal before being authorized under any circumstance,f em the owner,or I am authorized by the owner of this properly to pertcrm the work for which applicatlon is made, <br /> and I comply with the State Contractors Law 98.27 RCW and 29e.200A WAC. <br /> Clty of Everett Official Ula p„ly <br /> )weer/Authorized Agent Sign tura eta (Revised 6/20/2016) <br />