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11/18/2016 FRI 9: 35 FAX 425 257' 1666 CM Heating U003/003 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)evsrettepagavere(twa.gov I www.everettwe,gov/perm Its <br /> '77 i $IrE.'INrQ.�MA�'ION ``;''v.; <br /> PROJECT SITE ADDRESS: Q7 13-19 5t- Se, (4— 12(bti PROPERTY TAX M <br /> LEGAL for new construction: Short Pletisubdlvlslon Lot No, (attach copy of long legal deacrlptlon) <br /> CONTACT"INPORMATIO,N` i:;" <br /> OWNER NAME: -{� D �S TENANT NAME If Commorclal : <br /> OWNER MAILING ADDRESS: STREET I.�.bU �� Sy Se <br /> CITY STATE AIA ZIP <br /> OWNER PHONE: 2 1 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> pp CITnnY STATE VIIA— ZIP <br /> CONTRACTOR PHONE: �I �1CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSL #(REQUIRED): ?Gt{rlCITY OF EVERETT BUSINESS LICENSE#(REOUIR ): CBD R <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Spaclfy) <br /> CONTACT NAME: II CONTACT PHONE; <br /> {I�r CONTACT EMAIL: �Q� ' <br /> BUILDING PERMIT APPLICATION <br /> ExIstIng Use of building: Contract Prlee of Work; $ � <br /> Pro osed Use of Buildin Heat Source; AGas ❑Electric ©Other <br /> Bulldln Type: FR-Detached 1:15FR-Attached ❑Du lex ❑Multl-Famll 4 of Unite: []Commercial ❑Industrial <br /> Type of Project: ❑New ddltlon ©Remodel ❑Re air ❑T,I, ❑Sin QS rinkler ❑Demolltlon ❑Chan a of Una <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if a Ilcablo : <br /> MECHAN1dAL'PEftMIT'APPLj0A*ION: ;'I'', PLOMBING PCRMIT'APPLICATIQN <br /> TYPe of Projectl _New _ Addn _Alteration _Repair Type of Project; _New _Addn _Alteration `Repair <br /> #of List of Flxfuns #of <br /> Fixtures Flxture9 List of Fixtures Fixtures List of Fixtured Fixtures List of Flxturas <br /> A/C—Air Handlini Units Heat Pump Toilet Backflow Preventer(Inside Bld <br /> Forced Air System s Unit Heater Bathtub Urinal <br /> Gas Pf Inc Boiler Lavatory(Wash Basin Drinking Fountaln <br /> Water Heater Refrigeration Shower Floor Dreln <br /> Gas Fireplace Wood Stove Kitchen Slnk&Disposal Grease I-rap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other; <br /> Exhaust Fan Sink Service/Bar/Mo /eto. Other: <br /> ''SPRINKLER�I'StJPPR@t;81QN $YSTEM <br /> Number o ea e <br /> ACKNOWLEOOEMENT:I have reviewed this eppliestlon end confirm the Information conralnad haroln Is true and correct. Work done pursuant to this permit must comply with <br /> current federal,stat®,and local iaw- The granting of a permit only rauthorizas approved work and no devlations therefrom.Dev/at/ons must Ast be authorized In writing from the <br /> BUIldtng Official before being authorized under any circumstance,i an,the owner,or I am authorized by fere owner of this property to perform the work for which applteat/on Is made, <br /> and I comply with the Slate Contractors Law 16,27 RCW and 206.200A WAC. <br /> City of Everett Ofliclel Use Only <br /> 12/ PEM3 <br /> O n rlAuthorl2ed Agent Signature Date (Revised 9/23/2096) <br />