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09/09/2016 FRI 9: 19 FAX 425 252 1666 CM Heating 0002/002 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 08201 <br /> (p)425-257-6810 FAX 426-267-8857 1(E)everettepa@everattwa.gov 1 %vAw,everatlwa.gov/psrmlts <br /> Blue c`I';Blai l IIrr1� ,.AIY P.� �' a R.R0jP—d�' SIT ',INF,O , ATI,O,N <br /> PROJECT 9ITE ADDRESS: 19 PROPERTY TAX#: <br /> LEGAL for new conetructlon: Short Platlaubdivlalon Lot No. (attach copy of long legal d3scrlptlon) <br /> °�ONbcYiNFORMydtlo� <br /> OWNER NAME: TENANT NAME If Commerelal): <br /> OWNER MAILING ADDRESS: sTrir�r of <br /> CITY STATE rl ZIP <br /> OWNER PHONE: Q g ( OWNLR EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE c.,�) ZIP _ aQ <br /> CONTRACTOR PHONE: /�f ��JJ1� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):v4 (J a I )'I CITY OF EVERETT BUSINESS LICEN:3E 4(REQUIRED): <br /> ., . . <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: r CONTACT PHONE; Cf ps <br /> CONTACT EMAIL: <br /> rn <br /> Existing Use of Building: Contract Price of Work; $ .+� <br /> Proposed Use of Bulldin Neat Source: ❑Gaa ❑Electric Mother <br /> Building Typo: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Contmarcial ©lndustrlal <br /> Type of Project: ❑New []Addition ❑Remodel ZRepair ❑T.I. ❑S! n ❑S rinkler El Demolition ❑Change of Use <br /> DESCRIPTION,OF WORK: e> <br /> c:bv_pe(A-�Dy-�s OYI <br /> -\0i X'tYvi p ct�a tri I,`, - ►v�tV l eQf�J�VjvS La, (ice <br /> _(. }{ QQ���cA s -�r-ex +a �W-r <br /> ASSOCIATED BUILDING PERMIT# If appllcable ,, I(v0(,a_l7tvLi <br /> Omit','�`, IiLIC'ATI'0 <br /> Typo of Project: _Naw _ Addn _Alteration KR@pair Type of Project: New Addn Alterellon Repair <br /> #ofof #List Of Fixtures # Of #of <br /> �fxturea Fixtures List of Flxfurea F/xturas Lis(of F7xfurea Fixtures List of Flxturee <br /> A/C—Air Handling Units Heat Pump Tolle( Backflow Preventer fnslde Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boilar Lavatory Wash Baeln Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sfnk&Dls osal Greasa Trap <br /> Gas Ran a DuctinU Dishwasher Roof Drains <br /> lcthes Dryer Hooku s Other: Clothes Washer Medical Gas <br /> Ren a Hood Water Heater 7 <br /> Other: <br /> Exhaust Fan Sink (Service/Bar/Mop/etc. Other: <br /> Number or tiaaCiS <br /> ACKNOWt EDGEMENT.•1 have fovlowed this applla81/en and confirm ilia Information confa/nod herein Is true and correcl. Work done pursuant to this permit mus(comply with <br /> current federal,stets,and local law. The granting of s permit only aufhorizes oppraved work and no doviall0r15 thar®from.devle0ons must first be outhor/zed 1n writing from the <br /> 8011d/ng offlclel before being authorized undor any clrcumstance, lam the owner,or l am authorized by the owner of this property to perform ilia work for which applicstlon 11 medo, <br /> and I comply with the Stele Contractors Law 18,27 RCW and 296,2ooA WAC. <br /> (� I(,� City of EVareft Offlclaf Use Only <br /> PEW 2 <br /> L_/)�, � Z /�-Owner/Authoflxed Agent Slgrl tune Date (Revised 5120/2616) , <br />