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12/13/2016 TUE 9: 01 FAX 425 252 1666 CM Heating U002/003 <br /> PERMIT APPLICATII <br /> BUILDING / MECHANICAL / PLUMBING /SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-881 D FAX 425-257-8857 (E)eve rettepa(Meverettwe.gov I www.everettwa.gov/permits <br /> "PRO tCT`$IT�.'I�I �T�Q.N <br /> #:PROJECT SITE ADDRESS: 0 !� r �e,' o : <br /> PROPERTY TAX <br /> LEGAL for new construction: Short Plat/subdlvlafon Lot No. (attach oopy Df long l(a®al descrlptlon) <br /> ` � �. ;40 'CA�`� 11�pORM11 IQIV .,, ,. ,• , ; <br /> OWNER NAME: TENANT NAME(If Commerclal): <br /> OWNER MAILING ADDRESS: sTREer I ei3f <br /> CITY STATE Zip W <br /> OWNER PHONE: c� Lp(� OWNER EMAIL; <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRE88: STREET <br /> CITY STATE A �• ZAP GO/ <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: } <br /> CONTRACTOR LICENSE#(;;jC <br /> CENSE#(REQUIRED); D <br /> -7 <br /> CITY OF EVEFtETT BUSINE65 LI <br /> PRIMARY CONTACT: ❑ONTRACTOR ❑ OTHER(Please Specffy) <br /> CONTACT NAME: CONTACT PHONE: O� <br /> CONTACT EMAIL; con—, <br /> ,:; :I�I�IiL _I ..�`;� Y'" >p �,`.I `ATI ,1(I,, ,•.�:.r ,. r , . . <br /> ExIating Use of Dulldln : Contr6ct price of Work:'S ( r O <br /> 'Pro orad Use of Buildin Heat Source: []Gas )5aSectrfc ❑Other <br /> Building Type! FR-Detached ❑SFR-Attached ❑Duplex []multi-Famll -ft of Unite: ❑Commerclal l�lndustriai <br /> T a of Protect; ❑New ❑Addltlon ORemodel ❑Re air ❑T.l. ❑SI n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> IvI� H!#Ma4 A R�UI �':� PI 1 A 1' 1�. ,'PLUIVII�IN 1;' IkIMT A �' 1 <br /> type of Protect: ,New Addn <br /> —Alteration _Repair Type or Project; _New _Addn Alteratlon _ <br /> urea #of Lis <br /> # #of Of List of Flxt <br /> Flxiuras Fixtured List ofFlxturea LisI of Fixtures #of List ofF/xturea <br /> Fixturad Flxfures <br /> A/C--Alr hiandlln Units Ne®t Pump Toilet Backflow Preventer Inside Bid <br /> Forced Air Systema Unit Heater Bathtub U <br /> Cas Piping Boller LavatoryWash Basin nal <br /> rrinking Fountain <br /> Water Heater Refrigeration— Shower Floor Drain <br /> Gae Fire lace Wood Stove Kitchen Slnk &—Disposal <br /> Gas Range Grease Trap <br /> Ductln Dlshwashor Roof Drains <br /> Clothes D er Hooku a Other: Clothes Washer Medical Gas <br /> Ran e Hood <br /> Exhaust Fen Water Heater Other: <br /> Sink Service/Bar/Mo /etc. Other; <br /> um er OT Heada <br /> CKNOWLEDQEMENT;lhave ravlawod this eppllcaflon and confirm the Iocai law. The grantinof a lnformatlon <br /> contained herein Jr true and correct. Work done pursuant to this permit must comply with <br /> urrant federal,stare,and , g permit only authorizes approved work and no devlations therefrom.Dov eOons must first ba authorlrad in writing from the <br /> 11jlld/ng off ctal before 6a/ng aulhorirad under any c/rcumstance,I em tha owner,or/em authorized by the owner of this property to perform the work for which appucat/on Is made, <br /> rid I comply with the State Contractors Law 18.27 PCW and 296.200A WAC. <br /> City of Everett official Use only <br /> PR T# <br /> Z 13�I �a 2 — 02� <br /> n r/Authorized Agen1 Signature Date <br /> (Ravlsed 9 23 2016) <br />