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03/14/2016 MON 15: 49 FAX 4252521666 OM Heating 001/002 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D CEDAR STREET,EVERETT,WA 99201 <br /> (P)426-257-8810 1 FAX 425-257-8857 1(E)everottops@everettvva.gov I vAvw.everettwa.gov/permits <br /> PROJECT SITE.INPORMATION ' <br /> PROJECT SITE ADDRESS: lo PROPERTY TAX#: <br /> LEGAL for now conetructlom Short Plat/subdlvlslon Lot No. (attach copy of long legal deacrlptlon) <br /> 6', J0,04TACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Cornmorclal): <br /> OWNER MAILING ADDRESS: araeeT <br /> C FrY4$5�r STATE ZIP <br /> OWNER PHONE; � OWNER EMAIL; <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS; STREET LIE <br /> 1 <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: �j CONTRACTOR EMAIL: t <br /> CONTRACTOR LICENSE#(REQUIRED): 921g=1nL <br /> CITY OF EVERF-TT BUSINESS LICENSE#(REQUIRED): 1 <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT AME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> , , ;I„, ,1,1•I ,,.I �.,,, UUILDING',PLRMIT APPLICATION <br /> Existino Use of Bulldln Contract Price of Work: $ <br /> Proposed Use of Bulldln : Heat Source: *as ❑Electric 7101her <br /> Bulldln Type: ❑SFR-Detac ed FR-Attached ❑Duplex ❑Multi-Femil -9 of Units: LICommsrcial ❑Industrial <br /> Type of Pro act: ew ddition ❑Remodel ❑Re air ❑T.I. ❑SI n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK; <br /> ASSOCIATED BUILDING PERMIT# If a CE,lcable : <br /> .',t �III�CFIANICAL''R,ERMI'k APP,LIagT1ON PLUMBING PERMIT APPLICATION <br /> Type of Project: _New TAddn Altaratlon _Repalr Type of Project: _New "Addn _Alteration --Rapalr <br /> 0 of N of <br /> F!x urea List of Fixtures Fixtures List of Fixtures Fl aures Fixtures List of Flxturas #°f List of Fixtures <br /> A/C—Alr Handlin Units Heat Pump Tollet Backflow Preventer 'Inside Bid <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping BCIter Lavatory Wash 13aSln Drinking Fountain <br /> Water Heater Refrl erafion Shower Floor Draln <br /> Gas Fire Taco Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran a DuctIng Dishwasher <br /> Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Service/bar/Mo /etc. Other: <br /> .SPRINKLER/`SUPPR�S$lON'SYSTEM' <br /> um bor of Heads <br /> ACKNOWLEOOEMENT:I have reviewed this uppticaWn and confirm the information confa/nod herein Is true and correct. Work done pursuant fo thls parmlf must comply with <br /> current federal,state, and loco(low. The granting ora permit only authorizes approved work and nv devialigns thorofrum,Dev(o6ons must first be authorized In wrlt/ng from the <br /> Building Official before being eulhorized undor any circumstance-I am the owner,or!am authorized by the owner of this propwtty to perform the work for whlah applicet/on Is made, <br /> and I comply with the State Contractors Lew 18.27 ROW and 296,200A WAC, <br /> Cl(y of Everett Offlclat Use Only <br /> PERMIT# <br /> Z, � Ml �;?--* <br /> Owner/Authorized Agent Slgnat e pato (Rov/seri 10/1&2015) <br />