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10/13/2016 THU 13: 22 FAX 42Is2 1666 CM Heating 0 IZ008/008 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32DO CEDAR STREET, EVERETT,WA D5201 <br /> (P)425-257-BB1 D 1 FAX 425-257-8857 1(E)everetteps@Bverattwa.gov I www.everettwa.gov/parrnits <br /> Blue pr 6lark ('nk Only Pleatia Pk0ir T $�T� INFO MATION <br /> PROJECT SITE ADDRESS: 300 z-�tk PROPERTY TAX#: <br /> LEGAL for now constructlon, Short Platlsubdlvlslon _ Lot No, (attach copy of long legal dascrlpUon) <br /> CONTACT INFORMt#'Y'ION <br /> OWNER NAME: TENANT NAME (If Commerclalj: <br /> OWNER MAILING ADDRESS: STREET rT <br /> CITY STATE w ' ZIP CJ ZD( <br /> OWNER PWONE: �(pj OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STReET U15 ( � <br /> CITY 9TA7EWdL ZIP <br /> CONTRACTOR PHONE: 1 CONTRACTOR IEMAIL; <br /> CONTRACTOR LICENSE#(REQUIREO)in od- CITY OF EVERETT 131.1$INESS LICENSE#(REQUIRED); Cj <br /> PRIMARY CONTACT; ❑OWNER CONTRACTOR ❑OTHE-R(Please Specify) <br /> CONTACT NAME: CONTACT PHONE; a L <br /> CONTACT EMAIL: <br /> A ;'p41A'1'k�rv'; <br /> ExIsting Use of Building: Contract Price of Work: $ <br /> Proposed Use of Bulldin <br /> p Haat Source: as ❑Electric ❑Other <br /> Bulldin Typo: SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famif -#of Units: OCommercial ❑industrial <br /> T e of Pro ect: EINew []Addition ❑Remodel ❑Re air 13T.L ❑SI n ❑S rinkier ❑Demoli(lon ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> "a-ck-' W <br /> ASSOCIATED BUILDING PERMIT# If applicable): <br /> PL,U MN'+ '`��RhiI,MT '; h�CATIbN <br /> Type of Project; _Naw Addn Alteration `Ropplr Type of Project: _New _Adds Alteration Repair <br /> #of t_!s!of Flxturg� �#of ' <br /> f <br /> Fixtures Fixtures L/st of F/xturos Flxturae Llst of Fixtured FixturesList of Fixtures <br /> A/C-Air Handlfng Units Heat Pump Tolle! Backflow Preventer Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtuh Urinal <br /> Gas Pip <br /> jnqBoller Levator Wash Basin Drinking Fountaln <br /> Water Heater Refrl oration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& Ds osal Grease Trap <br /> Gas Ran a Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medlcel Gas <br /> Ran a Hood Water Hea(er Other; <br /> Exhaust Fan Sink ServicelBar/Mo /etc, Other: <br /> Num er o ua s <br /> ACKNOWLEDGEMENT:1 havo r6vlewed this applicallon and confirm the Information contained herein Is true and correct. Work done pursuant to this perm!/must comply with <br /> :urrent 16deral,stale,and local law. The granting of a permit only authorizes approved work end no devlatlons Cher®from,Devlatlona must first be authorized in wrllb7g from the <br /> 3vildtng Offlclal before being authorized under any a/rcumstanca.I am the ownor, or l em authorized by the owner of this properly to perform the work for which application Is made, <br /> Ind I comply with the State Contractors Law?9.27 RCW and 296.200A WAC. <br /> City of Everett Offlclal Use Only <br /> PERMIT# fy� <br /> DwnerlAuthorixed A ant SI n tura 1 ) �1 <br /> # Dae Revised S/20/2096) <br />