Laserfiche WebLink
10/20/2016 THTJ 15: 45 FAX 425 252 1666 CM Heating U003/005 <br /> • PERMIT APPLICATION <br /> BUILDING I MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-881 D I FAX 425-257-8857 i(E)everottepBQ®verettwa.yov I www,overet(wa.gov/permits <br /> B1u'�' 60'0104; Ink 4`in1Y pl��sa GPRCS �Ct SI .e I� ookMAT1©N <br /> PROJECT SITE ADDRESS: PtiSLE 1PROPERTY TAX#: <br /> LEGAL_for new conetructlon: Short Platisubdlvlslon Lot No.___ (attach copy of long legal description) <br /> CONTACT" 11400khAk 'ION <br /> OWNER NAME; TENANT NAME (If Commorcial): <br /> OWNER MAILING ADDRESS: STUCT <br /> CITY STATE zip �. <br /> OWNER PHONE; C)2 032-61 OWNER EMAIL; <br /> CONTRACTOR NAMi=; <br /> CONTRACTOR ADDRESS; STRFCT (� <br /> CITY STATELoa ZIP <br /> CONTRACTOR PHONE: 4 CONTRACTOR EMAIL; S <br /> CONTRACTOR LICENSE#(REQUIRED)tC , � t l �� CITY OF EVERETT BUSINESS LICENSE ff(REQUIRED): G�g <br /> . . <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR I] OTHER(Please Specify) <br /> CONTACT NAME; n� �`` CONTACT PHONG; a `-9 d <br /> EMAiL: � �� m <br /> Existing Use of Building: Contract Price of Work: S — n <br /> pro osad Use of Buildin : Heat Source: OGas Electric ❑Other <br /> Building T e; SFR-Detached O$FR-Attached ❑Du lex 173Multl-Famlly-#of Units ❑Commercial ❑Industrial <br /> Type of Proect: ❑New MAddltlon T Remodel pRe alr OT,I. MSI n ❑5 rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# If a ticable : <br /> OAT <br /> 1,0N <br /> Typo of Project: _New _ Addn _Alteration _Repair Type of Project: Now _Addn ` _Alteration `Repair <br /> /!of List of Fixtures #Of #of of <br /> Fixtures F/xturee, Fixtures List Of Fixtures List pf Fixturas #Flrtures Llst of Fixtures <br /> A/C—AirHandlin Units Heat Pump Toilet Backflow Preventer Inside Bldg) <br /> Forced Air Systems Unit Healer Bathtub Urinal <br /> Gas PipIng Dollar Lavatory Wash Dasln Drinkln Fountain <br /> Water Heater Refrigeration Shower Floor Draln <br /> Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap <br /> Gas Range DuctIng Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater <br /> Other; <br /> Exhaust Fon Sink (Service/Bar/Mop/etc. Other: <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have revlewed this application and confirm the information conisinod herein la Iruo and correct. Work done pursuant to this permit must comply with <br /> wmenf federal,state, end local law. The grantbig of s permit on)y authorizes approved work Mono deviations therefrom.Devlatlons must first be authorized in writing from the <br /> 300119 Offlciel before being aufhorizad under any circumstance, I am the owner,or I em authorized by the owner of this property to perform the work for which application is made, <br /> ,nd I comply wlih the Stmt®Contractors Law 18.27 RCW and 29e.200A WAC, <br /> "Z7PECity of Everett otficist use Only <br /> w l <br /> Wwm <br /> )wnerlAuthorized Agent Sign tura D `J <br /> to (Rev sed 5/20/2076) <br />