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12/05/2016 MON 9: 49 FAX 425 252 1666 CM Heating U002/002 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 90201 <br /> (P)425-257-8810 I FAX 425-257-9857 i(E)evoroltepseeverettwa.gov I www.evereltwa.gov/permits <br /> BIu( pr`'ISL K`Ink'ohl PI Pr#'pjlect.$0101.1.0,644i4.064. -:- ,. <br /> PROJECT SITE ADDRESS; I 30 '6-1' loi I ao K_01 <br /> c PROPERTY TAX* <br /> LEGAL for new construction; Short Plat/subdIvIslon Lot No, <br /> (attach copy of long legal d9ecrlptlon) <br /> � ��� ;;�CO�'� <br /> OWNER NAME: 47 C?. t-r `�'0YG� ..� <br /> �� TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: STREET �(,�ll-f 36 LO es f CSl 'k � - <br /> CITY " " -'�c/�+-11/l/1 � <br /> ' <br /> STATE ZIP '9(el .0til <br /> OWNER PHONE; -C)/..4c) 3L( -7(P 32 OWNER EMAIL; <br /> CONTRACTOR NAME; ,:ddd / R d <br /> CONTRACTOR ADDRESS; 5TriEET 1.1 •; 'Bo <br /> p ic <br /> CnY ' I t:ail LJ 1.-{)Q,./� <br /> U STATE - ZIP '20/ <br /> CONTRACTOR PHONE; LIR/ G't -- CONTRACTOR EMAIL; aL - dg1PC?l, l-1)0-- " <br /> CONTRACTOR LICENSE#SIRED : r 1 Qa` ) <br /> ) � 7 7c�.1� CITY OF EVERETT BUSINESS LICENSE t9(REpUIRED): lP0 <br /> PRIMARYCONTACT; LI OWNER <br /> ,CONTRACTOR 0 OTHER (Please Specify) <br /> CONTACT� NAME: - CONTACT PHONE; q��7 a os5 , <br /> V V-__ r) CONTACT EMAIL: <br /> e,41,/,-ur...zti • . M <br /> i. 1)1LbIN( ;PE Mid A ' Lio•- liON ''* <br /> Existing Use of Building: Contract Price of Work; $ -30 Orr) <br /> Pro.osed Use of 13ulldln•: Heat Source: DGas CIEiectric ❑Other _ <br /> Building Type: POS FR-Detached ❑SFR-Attached El Duplex OMuIN-Famif -#of Units: ❑Commerclai ❑Industrial <br /> T e of Pro act: ONew ❑Addition ❑Remodel 1DRe air ❑T.I, OSI n DS rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK; <br /> Com. <br /> I <br /> ASSOCIATED BUILDING PERMIT# If a Ilcabla ; <br /> MACH' Nlg4*PRIVI :40144 A}I'IO . . 'u '>, <br /> .,` - ' ' '' R4VM,�IMR���IZr�I.IIT"oAiF/�► iCt TION <br /> type of Project: New Addn � � � '" <br /> _Alteration Repair Type of Project: New _Addn .Alteration Repair <br /> N of List of Fixtures <br /> Fixtures Fixtures List of Fixtures List of Fixtures of List of Flxfuros <br /> Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump _ Toilet Backflow Preventer(inside Bldg) <br /> f Forced Air Systems Unit Heater Bathtub <br /> - - Urinal <br /> Gas Piping g Soifer Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower a — <br /> Gas Fireplace Wood Stove r- T Floor Drain <br /> Kitchen Sink&DIS osal Grease Tra <br /> Gas Range Ducting Dishwasher <br /> Clothes Dryer Hookups Other; RoofDrains <br /> Clothes Washer Medical Gas <br /> Range Hood Water Heater - <br /> Exhaust Fan Other: <br /> Sink(Service/Bar/Mop/etc.) Other; <br /> '''','4:,',.701014,R$«.0....1/.40:00,g. F,.$ION I j'*j M :j7,17 <br /> umber of cads <br /> CKNOWLEDGEMENT.'1 have reviewed this application end confirm the Information contained herein Is true and correct. Work done pursuant to this permit must comply with ' <br /> urrenr faders!,state, end local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first bo authorized in wilting from the <br /> 'Lidding Official before be/ng authorized under any circumstance,I am the owner.or I am authorized by the owner of this property to perform the work far which epp//cation is made, <br /> nd I comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> II s i' `� / l� • .4v4 4.4a-- <br /> L2- L' <br /> / PEi c 7 ., r <br /> cx34_ i <br /> n tr/Authorlzad Agent Signature (�! <br /> Dale (f2evised 9/23/2016) <br />