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08/08/2016 MON 10: 19 FAX 425 292 1666 CM Heating U002/002 <br /> PERMIT APPLICATIOI <br /> BUILDING i MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-6810 FAX 425-257.6867 1 (E)everetlepsgoversttwa.gov 1 www•e+rereftwo.gov/perrnita <br /> PROJECT 817E ADDRESS: 3 (� PROPERTY TAX#: <br /> LEGAL for new Conatructlon! Short Plat/subdIvIslon Lot No. (attach copy of long legal descrlptlon) <br /> 1 ook •ATION <br /> OWNER NAME; TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRE STREET t 1 e <br /> Y� <br /> CITY STATE V1r ZIP <br /> OWNER PHONE; OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET LA <br /> I <br /> CITY <br /> STATE ZIP <br /> CONTRACTOR PHONE: ( CONTIRACTOR EMAIL; ryC� <br /> CONTRACTOR LICENSE#(REQUIRFO) -Tldrl ICITY OF EVERETT BUSINESS LICENSE#(REQUI( ED): <br /> PRIMARY CONTACT; Q OWNER ONTRACTOR ❑OTHER(Pleaee Speclfy) --CONTACT NAME; ., � CONTACT PHONE: <br /> �n1C�U�I CONTACT EMAIL: <br /> a L <br /> ExIsting Use of Bulldln Contract Price of Work:$ <br /> Pro orad Use of Bulldln : Heat Source: ❑Gas [JElectrlc ❑Other <br /> Bulldln Type; ❑SFR-Detached ❑SFR-Aiteched ❑Du lex QMulti-Famll -#of Units: C]Commerc)el ❑Induetrlal <br /> T a of Project: ❑New []Addition �7Remodel ❑Repair ❑T.I. ❑SI n ❑5 r)nkler OUemofltion ❑Chan a of Use <br /> DESCRIPTION OF pRK; <br /> a0f v� W i`{ a� <br /> ASSOOIATED BUILDING PERMIT# If a Iloable : ob Cues( ALX- klbuise <br /> Type of Project: _NOW _ Addn _Alteration _Repair Type of project: Naw _Addy • Alteration _Repair <br /> #Of Lfat of F!x(urBa Fixtures 0 #of #of <br /> Fixtures P7xtures Litt of Fixture9 List of Fixtures W5r o/Fixturoa <br /> F1r[t�rjs <br /> A/C—Alr Handlirm Units Heat Pump Tolletackfiow Preventer Inside Bldg) <br /> Forced Air S atoms n To t eetd u Urnal <br /> Gas Piping p I®r Lav®tory Wash as r, DrInkIng Fountaln <br /> Water eater a rl sratlan Shower Floor Drain <br /> Gas Fireplace Wood Stove Kltc en Sink&Dls oval Grease Trap <br /> Gas Range Ductin Dlehwasher Roof Drains <br /> Clothes Dr <br /> yer Hookups ther: Clothes Was Or Medical Gas <br /> Range Weter ea(er Other: <br /> ExhaustFan Sink ServicelBar/Mo lefc. Other: <br /> er o ee g <br /> ACKNOWLEDGEMENT.,I have revlawed this appllcatforl and donfirm the information contained hereln is true and comet!. Work done pursuant to this perm)(must comply with <br /> current faderal,state, and local law. Tho granting of A permit only authorizes approved work and no deviations therefrom.Dsvlattcns must ftref be authorized In wrillna from the <br /> Building Offlcial before being authorized under g11y clroumatance.1 arty the owner,ori am authorized by the owner of this property to pt,rform the work for which application is m <br /> and I comply with the 5tete Contractors Law 18.27 RCW and Z96,200A WAC. ade, <br /> Chy of Evsrotl Off ciel Use Only <br /> --- <br /> PERMIT# <br /> Own®rlquthorizad Agent Slgnatun Oaf© evised 5/20/2016) <br />