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09/29/2017 FRI 12: 06 FAX 425 252 1666 CM Heating U001/003 <br /> CAY� �44 es Fo?� Fa S- .2 Sq 0 5407:) <br /> PE MIT PPLICATION <br /> BUILDING 1 MECHANICAL/ PLUMBING/SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 9a201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)evarettepc2everettwo.gov I www.overettwa.gov/permits <br /> Blue or Black Ink Only Ploaso) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: r; \3 Ls)�-Lm PROPERTY TAX N, <br /> LEGAL for new construcilon: Shari Plut/Wu divlslon Lot N0. (attach copy of Ione legal dasurlptlon) <br /> CONTACT INFORMATION <br /> OWNER NAME: oL n Yi TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY .Q�` STATE Zia <br /> OWNER PHONE: Z.15 3 2 ��} OWNER EMAIL; <br /> CONTRACTOR NAME: G — <br /> CONTRACTOR ADDRESS: STREET I q 11 <br /> CITY STATE VA z'P <br /> CONTRACTOR PHONE: 2—ro( CONTRACTOR EMAIL; b <br /> CONTRACTOR LICENSE#(REQUIRED): �' /� CITY OF EVERETT BUSINE56 LIGEN159 P(REOUIR1217): i <br /> PRIMARY CONTACT: PCOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONN E: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use Df Bulldln Contract Price of Work: S <br /> Pro owed Use of B Iden Heat Source: []Gas ectfic ❑Other <br /> Bulldln Type: FR-Datached OSFR-Attached ❑Du lux ❑Multi-Famil -#of Unita: QCommerclal []industrial <br /> Typo of Pro e : tNew ❑Addition ❑Remodel []Repair ❑T.I. ❑Sign ❑Sprinkler ❑Dernolltlon OChan a of Use <br /> DESCRIPTION OF WORK: <br /> ����� +�� <br /> ASSOCIATED BUILDING PERMIT# if applicable)! <br /> MECHANICAL. PI?RMIT APPLICATION PLUMBING PERMIT.APPLICATION <br /> Type of Project: _Naw _ Addn _Alteration _Ropalr Type of Project: New __Addn _Alteretlon Repair <br /> #of ust of Fixtures #of <br /> Fr„durea Llef oI Fixtures List of Flxlun <br /> Fixturoa Fhrtures s Fixtures List of Flstureg <br /> A/C—Air HandlingUnits Heel Pum Toilet Backflow Preventer Inalde Bldg) <br /> Forced Air systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller Lavatory Wash Basin Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Dreln <br /> Gas Fireplace Woad Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Dralne <br /> Clothes D or Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other- <br /> Exhaust Fan Sink (Service/Bar/Mop/etc. Other: <br /> SPRINKLER/BUPPRES31OK SYSTIEM <br /> Chemical or Water I INa- <br /> ACKNOINLEDoEMEN r I heva reviewed this applloeflon and oon&m the Information contained heroin/a true and cormcf. Work done pursuant to this permit must comply w0th <br /> current toderel,state,and local law. The grandnp of a permit only autltatlzoa approved work and no devistlona therefrom,Devieflons must first be authorized In writing from the <br /> Building OMC/al 6afore Aa/ng authorized under any circumstance.I em the owner,or 1 am authorized by the owner of fh/s properfy to perform the work for whlch appAoanon la made, <br /> and I Comply with tho Sfafo Contractors Lew 1827 RCW and 298.200A WAC. <br /> Cty of Evers rt Officlal Use only <br /> PERMIT# <br /> - P( - DC <br /> OwrlAHAuth011�Led Agent Signet re Dala Revlsa <br />