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03/25/2016 FRI 17: 24 FAX 4252521666 CM Heating 0002/003 <br /> PERMIT APPLICAT10im <br /> BUILDING / MECHANICAL / PLUMBING if SIGN /SPRINKLER i DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-13810 1 FAX 425-257-0857 1(E)averettepsoavarattwa.gov vAm.everettwa.goy1perrnIts <br /> 0 <br /> 0 <br /> � <br /> PROJECT SITE ADDRESS: r 1PROPERTY TAX#; <br /> 3 <br /> LEGAL for now conutructlon; Short PIA/vubdivlalon L/ Lot No. (attach copy of long legal deecriptlon) <br /> OWNER NAME! TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRIISS; sTSCLIT 16R/t <br /> CITY STATE ZIP <br /> -o f <br /> OWNER PHON=E-. (5 f��15 S�3 1OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET <br /> Crry -- STATEWA ZIP <br /> CONTRACTOR PHONE: S1 1CONTRACTOR EMAIL: t4 <br /> CONTRACTOR LICENSE II(REOUIRED): CITY OF EVERETT BUSINESS LICENSE ft(REQUIRED); tocil? <br /> PRIMARY CONTACT: 1:1 OWNER IACONTRACTOR 13 OTHER(Please Specify) <br /> CONTACT NAME; CONTACT PHONE: <br /> 1 5 <br /> 1CONTACT EMAIL: co <br /> Existing Use of BuIlding Contract Price of Work: $ icon <br /> Pro owed Use of Building; Heat Source: IqGas E]EIGotrIc ' COther <br /> Building Tyeo: 0SIFIR-DeFR-Attached ODuplex EIMulti-Famlly-4 of Units: OCommorclal Cindustrial <br /> Type of Project: DINew YvAddltlon -ORemodel ORepair EIT.I. CISIgn 135prinklor ElDomolltlur DChanga of Use <br /> DESCRIPTION OF,WORK <br /> U�sjaj <br /> JASSOCIATED BUILDING PERMIT#(if applicable); <br /> 4 <br /> EFtMIT..A <br /> 'Type of Project: _New A= Addn ­Alteretlon —Repair Type of Project: _Now –_Addn _Alteration _Repair <br /> Fl 0 of re$ List of Fixtures Fix#of Fix#tufq(of Fixtures of List of Fixturos Flxturf List of Fixtures#oxtuI tatea res aa <br /> JA(G–Air Handling Units Heal Pump Tollat Backflow Pravontor(inside Bldg) <br /> Forced Air Systema Unit Haatar Bathtub Urinal <br /> Gas PIpIng Boller LevatorV(Waah Basin) Drinking Fountain <br /> Water Heater RefrIgeratIon Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&01sposal Grease Trap <br /> Gas Ran qe Ductinq Dlshwasher Rout Drains <br /> Clothes Dryer Hookups Other: Clothes Waahor Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Servlue/Sar/Mopiletc.) Other, <br /> ii* F, <br /> "".777'*raL <br /> I Number of Heads <br /> ACKNCWLEDqFWENT,I have revlowed(hia application and confirm the Information contained herein Is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The gronflng of a permit only authorlzas approved work and no d"lations therefrom.Deviations must first be authorized In writinly from the <br /> Building offic/a/before being authorized Under any 0/rcumsfonce.I am the owner,or/am oulhortzed by the owner of this property to perform the work for which apptication Is made, <br /> orid f comply with the State Contracrq Low 18,27 RCW and 290.200A WAC, <br /> City of Everett Of lo/a/Use Only <br /> FERMIT <br /> Owner/Authorized Abent Silin-uture Data I (R6vls@d 10112120115) <br />