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06/21/2016 TUE 12: 57 FAX 425 252 1666 CM Heating 1003/003 <br /> PERMIT APPLICATIOr• <br /> BUILDING MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32DO CEDAR STREET, EVERETT,WA 98201 <br /> (P)426-257.8810 1 FAX 425-257-OB67 I(E)eve rettepe(Deverettwa.gov l www.everet(wa.gov/permlts <br /> �lu�e;e�`w, I��k�1 ��S?!f'a� �►1`�le�ai •, „ `Pl�t;►i� �'I:�I'1'>�' NFt �1111A`I'IOhY I <br /> r <br /> PROJECT SITE ADDRESS: con OR IPROPERTYTAX#: <br /> LEGAL for new conatructlon: Short Plat/aubdlvlslon Lot No. (attach copy of long logal descrlptlon) <br /> ;;,• y ,,r TACT •I� M. too <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS; STREET mnK)gg- <br /> an <br /> STATE zip <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAMEI <br /> CONTRACTOR ADDRESS; srRaer <br /> CITY STATE yl ZIP <br /> CONTRACTOR PHONE: r CONTRACTOR EMAIL; L' <br /> CONTRACTOR hICEN3E#(REQUIRED) i —1--Idn CITY OF EVERETT BUBINE88 LICENSE <br /> PRIMARY CONTACT; ❑ OWNER ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAM CONTACT PHONE: <br /> t�nr/1`r°,�, � CONTACT EMAIL: itH- <br /> EXIStIno Use of Building: Contract Price of Work; $ ' <br /> Proposed Use of Bulldln Heat 5ourca: mamas ❑Electric ❑Other <br /> Bulldln Type; MSFR-Detached FR.Altached ❑Du lex ❑Multi-Famll -#of Units: ❑Commarclal alndunlrlal <br /> T e of Pro act: ew ❑Addltlan CaRemodal ❑fie air ❑T I 0751 n ❑S rinkler �.JDemoptlon ❑Chen e of Use <br /> DESCRIPTION OF WORK: <br /> C2svr1C� i IN�e�rS, S p\p <br /> ASSOCIATED BUILDING PERMIT# 11If applicable): <br /> ll, t M11 :'!I rff4'1!;tr li. �t ri1M8: ir,lY:+r: fi.�il <br /> Type of Project: Naw _ Ad `m-dn r_Alteration Rapalr Type of Project: Now _Atkin Alteration Repair <br /> #of IIs(o/Flxfurea #Of <br /> Fixtures u Lfato/Flxfutea #Gf LlstofF/xturea <br /> List of Fixtures <br /> Flrfurp� Flxirrrea Fixtures <br /> AIC'—Air Handling Units Heat PLIMP Tolle( Backflow Preventor(Inside Bldg) <br /> Forced Alr Systems Vnit Heater Bathtub Urinal <br /> Gas PI In o ler Levator ash Basin rinkln Fountain <br /> Water Heater Re rl eratlon Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& i Deal Grease Trap <br /> Gas Range DuCtIng Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other Clothes Was or Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Service/®ar/Mo /etc, Other: <br /> Z <br /> um er ot Hea e <br /> ACKNOWLEDGEMENT:I have revIew9d this eppltcatlon and conOrm the lnformatlon conrolned heruln Is true and correct, Work done pbfgUant to this permit must comply with <br /> Current fadoral,state,and local law. The granfing vroo penult only aathorizes approved Work and no day/8110ns therofram,o®vlatlons must first be author/zed inV tit from the <br /> 8ulldbtg Offlola/before being euthorlzad under any olroumstanco.I am the owner, or I am author/zed by the owner o(thts property to perform the wort(far which appllcetlon is tnada, <br /> and 1 comply with the Stare Oontractors Law 18 27 ROW and 296.2ooA WAC. <br /> City ofE•veroft Offtclal Use Only <br /> �1 PERMIT <br /> 1 <br /> OwherlAutharized Agent 6lpnature Date (Revised 6/20f209 <br />