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05/31/2016 TUE 13: 03 FAX 425 252 1666 CM Heating 0053/003 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL, / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT, WA 88201 <br /> (P)425257-6810 1 FAX 425.2578857 1(E)evere,ttepa®evarettwa.gov i www.everettwa,gov/permits <br /> PROJECT SITE ADDRESS: t�� PROPERTY TAX M <br /> LEGAL.for now ounatructlon: Short Plot/aubdlvislon Lot No, (attach Copy of long legal description) <br /> g, r •fa 'i,i t � . '.r,. '�' • �, f�'T•[rl�lpQ�tNIATI�t� • <br /> OWNER NAME: TENANT NAME If Commercial); <br /> r <br /> OWNER MAILING ADDRESS: STREET l V <br /> --DR <br /> cirr ernre � ZIP- <br /> OWNER <br /> iP <br /> OWNER PHONE; ) C) i 6Z 0 OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRES$: QrReeT <br /> c'TM sra,re ziP <br /> CONTRACTOR PHONE; v1�'1 CONTRACTOR EMAIL: �'}(L �m(n <br /> CONTRACTOR LICENSE#(REQUIRLp) 7-Idn CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER VONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE; <br /> CONTACT EMAIL: <br /> ; ' •'ir;�S,�t°t 9'if''t�;;i•t r�11,•r�y1 G°rf ,�,, r�•') �n�,r rl�f xi I �, �y <br /> Existing Use of Building: Contract Price of Work: s—t4Kq 0 <br /> Pro osed Use of Bulldln Heat Source; as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached ❑Dy lex ❑Multi-Family-#of Units: ❑Commercial OIndustrlal <br /> Type of Project: ❑New JuAdditicin E]Remodel ❑Ra alr ❑T.I. ❑SI n ❑B rinklar ❑Demolition ❑Chen a of Uso <br /> DESCRIPTION OFF WORK: <br /> Pill ­Gf�, <br /> ASSOCIATED BUILDING PERMIT# If a ll <br /> cable <br /> icy 'µtl; �' »;iy ."J���if( l.�ir,'Y!/�)'y�r �!'.�'��i��r(L 1. 7 <br /> Type of Project: _New _ZL Addn _Altorgtlon Repelr Type of Protect: Naw Addn Alteration — <br /> Ropalr <br /> #Of L!r(o/Flxfurea o _-__ � — <br /> Fixtures Fix(VIVt L!s(o/Flxfurea Fixtures Mat of Fixtures Fixtu;�s L/st o/P/xturea <br /> A/C-Alr Handlingis <br /> Un Meat pUmp Tollat Backflow Preventer Inslda Bldg) <br /> Forced Air 3 stems Unit Heater 8offitub Urinal <br /> Gas Piping 0-116 r Lavator ash Besln) DrinkIng Fountain <br /> Water Heater e r oration 'Shower Floor Draln <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Range Ducting Dishwasher Roof brains <br /> Clothes Dryer Hooku aOther: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> + Exhau "Y T01 <br /> �s(t Fan f Slnk Servlce/Bar/Mo etc. Other: <br /> PA <br /> .7T � .. a'if�Fp1 .Rir <br /> 1' i <br /> Number o ea et LZ <br /> ACKNOWLt=DOaMENTr I have reviewed this application and confirm the information contained herein Is true and corract. Work done pursuant to this permit must comply with <br /> current iederaf,state,and local law, The granting of a permit only authorizes approved work and no deviations therefrom.DAVIatlons must first be authorized In writing from the <br /> Vullding Official bofora being authorized under any cirournatetnce-I am the owner,or I am authorized by the owner of this property to perform the work for which appllcati017 Is made, <br /> Hnd 1 comply with the Slate Contractors Law 18 27 RCW and 290.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent SignatureDat® (Revised 016 <br />