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09/06/2016 TUE 9: 05 FAX 425 252 1666 CM Heating 0002/004 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32DO CEDAR STREET,EVERETT,WA 9B201 <br /> (P)425-257-6610 I FAX 425-257-8857 1(E)everetteps@everetlwp,gov I www.everettwa.govlpermlls <br /> PROJECT SITE ADDRESS: 16 1toqA b"1— Scl PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/aubdlvinion Lot No. (attach copy of long legal tloeorlptlon) <br /> CONTAC7INQRMA'r Of� <br /> OWNER NAME; TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS; STREET `(�IoYI/1 <br /> olry STATE ZIP <br /> OWNER PHONE: 6 OWNER EMAIL: <br /> CONTRACTOR NAME. <br /> CONTRACTOR ADDRESS; STREET <br /> clTr STATE ZIP <br /> CONTRACTOR PHONE; 24 0 CONTRACTOR EMAIL: � ) <br /> CONTRACTOR LICENSE#(REQUIRED):Q{� �� n CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR E]OTHER(Please Specify) <br /> CONTACT NAME: r CONTACT PHONE: o� 59 <br /> CONTACT EMAIL; �1 E' frYl <br /> Existing Use of Bulldln : Contract Price of Work: $ <br /> Proposed Use of Suildin Heat Source: ❑Gas Ni�lectric ❑Other <br /> Building Typo: ❑SFR-Detached ❑SFR-Attached ❑Du lox ❑Multi-Family-#of Units: ❑Commerclal ❑Industrial <br /> T e of Project: ❑New ©Addltlon ❑Remodel ❑Re elr CIT,I, ❑51 n ❑S rinkler ❑Demolition LJChan e of Use <br /> DESCRIPTION OF WORK: / �� <br /> -Ihsk <br /> ASSOCIATED BUILDING PERMIT htif aR I pllcablo : <br /> Typo of Project: _New _ Addn _Repair Type of Project: _Now __Addn Altoratlon Repair <br /> #01 List of Fixtures #of — <br /> Ffxturos FlxturOs List of Fixtures #of List of Flxtur *of ea Llat of Flxtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units Heat P.urnp Toilet Backflow Preventer Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refr! eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas <br /> Range Ducting Dlehwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Wafer Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /eto. Other: <br /> t'$P IC R'/ <br /> 41i 0, <br /> um er of Heads <br /> ACKNOWLEDGEMENT;I have reviewed th'Is application and confirm the information contained herein Is true and 0orrect_ work dune pursuant to this permll must comply with <br /> current federal,stele,and local law. The grgntln®of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officlal before being authorized under any cltcumstance.I am the owner;or I am authorized by the owner of this properly to perform the work for which application Is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Oificlal use Only <br /> YTJ , 30 PERMIT <br /> Owner/Authorized Agent 5iAn tura Dale Revlsad 5/20f2016J <br />