|
�
<br /> O9/21/2p16 MON 12: 23 FAx a252521666 CM Heating f�002/003
<br /> PERMIT APPLICATtO
<br /> BUILDING / MECHANICAL I PLUMBING / SIGN / SPRIIVKLER / D�MOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAFt STREET, EV�R�TT,WA 98201
<br /> (P)42B-287-BB10 � FAX 425-257-BB57 �(�)evereltepa(�everetlwa.gov � www.everettwa,govlpermils
<br /> '�' ;` '�; '" . �, PRO�J�C,�'f' $1'�`� �II��ORMATION �� ., ��
<br /> PFi JEC SITE ADDRESS: rU p 1 PROPERTY TAX#:
<br /> I
<br /> LEGAL foT new canslructlon: Shon Pledeubdlvieion Lol No. (attech copy of IonE�leyal descriptlon)
<br /> ')zy �,,14 ��u,a��q"t'� , :;r��+����?�r � c v �r'ii� i , , � . .
<br /> ';� rs�;,,4,�,,,, .,��;�, `�, .;,' �� ,�,..aONTACT'�NFORMATION
<br /> OWNER NAM�; ` �, TENANT NAME(If Commercfal)i
<br /> OWNER MAILING ADDRESS: sTReeT �}')�� �
<br /> �►n' � srnre � xiP �
<br /> OWNER PHON�� "7 `� OWNER EMAIL;
<br /> CONTRACTOR NAME:
<br /> CONTRACTORADDRE33: sTaEeT �-Q` ��
<br /> r �
<br /> aTv srarE zip
<br /> CONTRAC'�OR PNONE: � C�NTAACTOR�MAIL: � � �„�.O
<br /> CONTR.4CTOR UCENSE#(REQUIRED); ' CITV OF EVERETT BUSINE83 LICEN$E#(REQUIR�C]);
<br /> ....
<br /> PRtMARY CbNTACT: C�pWNpR CONTRACTOR ❑ OTHER(Please Specify)__�
<br /> COPITACT AME: CONTACT PHONE: � �
<br /> ��'I � ��lV�� CONTACT EMAiL: (,1
<br /> ,�,.{�,ti,1,, ;f., +r. ,:, ,< <,.,..� �„•,�..�,, �,,,,;,..B.U��:D�NC3,PEi��IT ARP�IGATI�N ' "'r �
<br /> �r:r.'- �' ,�,� ,�, ,
<br /> �xlstln Use of Bulldln Contract Prico of Work: $
<br /> Pro o9ed Use of Bulldln : Heat Source: OGas ❑Efectrlc ❑Other
<br /> Bulldln T a: G7SFR-L7etached Ff2-Atlached ❑Du lax �IMulti-Famil -#of Unils: ❑Commerclal ❑Industrlal
<br /> T e of Proect: ❑New ddltion ❑Rsmodel ❑Re air ❑T,I. ❑SI n ❑8 rinkler pDemo�iltion ❑Chan e of Use
<br /> nESCRIPTION OF WOR t
<br /> �� "`--' ���l�
<br /> � �
<br /> A880CIATED BUILDIN(3 PERAMI7# If a Ucable :
<br /> "';;��,��''``MK��1�{#��M�'.,`L`,P�RMIT,ApRLICATION' ,� � , ' , ' � 'PLl,rhll�ING PERMIT APPLICATION
<br /> Typ�of Projact: _N�w Addn _p,ltaratfon _R�palr Type vf PrvJect� New _Acldn _�1ltoretlon ,_Repalr
<br /> �or tlaf ol Flx�uree
<br /> Flxt�rsa F/xfuroa �Iat of Flxture9 Fl�fu�8 Llsf vf F]xturea� F/xlu ea L/st of F/xturaa
<br /> A!C—A1r Handlln Unite Heat Pump To{let Backflow Preventer Inside Bldg)
<br /> Forcad Alr S stema Unit Haater Bathtub UrinAl
<br /> Oas PI In Boiler Lavato Wash Baeln Drinkln Fountain
<br /> Water Heater Refrl eration Shower Floor Draln
<br /> Gaa Fire laae Wood Stove Kitchen Slnk&Dls osal Grease Tra
<br /> Gae Ran o nuctln Dishwaaher Roof Dralns
<br /> Clathes or er Hooku e Othet: Clothes Washer Medlcal Gas
<br /> R�n e Hood Weter Heafer Other:
<br /> Exhauat Fan Slnk Servlce/Bar/Mo /etc. Other:
<br /> %'�'`'`�;��RI NKI;�R.";��,$U��PI�E$81QN�SYSTEM.
<br /> �,.,
<br /> Number o ea s
<br /> ACKNow�EDOEMENT.�!have rsvlewed this app/lcat/on end conl/rm fho lrtlormeNon con�a/nad hareln la Gue��d correct, Worlc done pursuan�to!h!e perm;f must comply wlth
<br /> cvrrenf federal,sfa(e,end/ocel lew. Tha�ranflnp of a permlf only autnorizas epproved work and no devlallons there/rom.Devlefrons must llrst be euthorized 1n wrlfl+��from the
<br /> Bulld7ng ONlclal beforo b9�np aufhodzed under e��y clrcumslenCe, I&rrr fhe owner,or 1 am authorized by tha ownar of t1t19 propar�y tv parform li�a wurh fo�whlch appl/cef/on 19 made,
<br /> and I comply wlth fha Slale Contraclors Lew 78.v RCwend 298.200A WAC.
<br /> CllyolEverettONlclal Use only
<br /> �/� � �� PERMIT# • '�n � ���
<br /> � �_� � I � o
<br /> OwnerlAuthorlsed ent Isna ure Dete Revlsed 10/17/2095} �
<br /> 16` �1� ��
<br /> ,
<br /> � a
<br />
|