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09/29/2016 THU 8: 47 FAX 425 252 1666 CM Heating l II 002/002 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everettepseaverettwa,gov I www,everetlwa.gov/permit: <br /> (Aline o ,fflalck.Onk OnIY•R,Ie€04)',. _ , '' :PRGJECt..:$I'll'„E'i.NFORMATipN'.' . • <br /> PROJECT SITE ADDRESS: ?r <br /> � �r v PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No._. . - - (attach copy of long legal description) <br /> . " , ,'. " ''' ., ,cON ,AC �Mr,'t„, :TOW • ' <br /> — <br /> OWNER NAME; 'NA-U.1- -tuuir eP- TENANT NAMEStf Commercial); <br /> OWNER MAILING ADDRESS; STREET AGI t C11-1 1 S•S V y V <br /> CITU eALTI9Y ill-ATE YIP 9 V <br /> OWNER PHONE: 9.90 . IOWNER EMAIL: <br /> CONTRACTOR NAME: a7 \ 4 •� <br /> CONTRACTOR ADDRESS; STREET 1•-1 • a/01 1 .:A <br /> r CITY W 121.7 , STATE W zIP (3 0,,t J <br /> CONTRACTOR PHONE @ :f.A () -) CONTRACTOR EMAIL:i C 1 3Ed1t d l Y l <br /> CONTRACTOR LICENSE#(REQUIRED):O{ hQ���; 11 CITY OF EVEREIT BUSINESS LICENSE f!(REQUI� G 0q <br /> W- <br /> PRIMARY CONTACT; ❑OWNER CONTRACTOR 0 OTHER(Please Specify) - <br /> CONTACT NAME: �, �r CONTACT PHONE; 5A - 90 <br /> T <br /> rill CONTACT EMAIL! 21l-(-� ,ri I�� T., <br /> ' �'p�•r .�•.�• y �' St,`' Moc _ '+ �( ., ,C, 3 �C�'P” <br /> .i'VP: %,.:'� .:' f. •',:.';.1';',14'60/111a [,•P 0/l ','.A�. ._! -,'.:,..:700,11..1 •+ ,. . <br /> Exlatint Use of Bulldln.: Contract Price of Work;$ e..' t.• <br /> Proposed Use of Building: Heat Source: IFIGes 1YLEIectric . ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex I IMultl-Family-#of Units: ❑Commercial Clindustrlal <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sp kler ❑Demolltlon ❑Changs of Use <br /> DESCRIPTION OF WOR • <br /> eplab2_ 8(3c -CuRiliato)L <br /> ASSOCIATED BUILDING PERMIT#(If appilceba) . <br /> i. 001$0y ■Nkill attlitatlAgl!.1i ," <br /> •.y 'r'IW.r0 r p 0 <br /> Type of Project) New Addn __Alteration _Repair Type of Pro sot: _New <br /> I _Addn _Alteration `Repair <br /> #Of List of F/xfursa #of #of #of <br /> FixturesF!x[ures List of Fixtures <br /> Fixtures— List of Fixtures <br /> Fixtures List of Fixtures <br /> A/C–AIr Handling Units Heat Pump — Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration. Shower Floor Drain <br /> des Fire lace ,T_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 Fan ___ Sink(Service/Bar/Mop/etc.) Other; <br /> umber of Heads <br /> Ali <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or!em authorized by the owner of this property to perform the work for which application is made, <br /> and i comply with the.State Contractors Law 18.27 RCW and 296.200A WAC. <br /> if <br /> Ott),ofEverettOfficial Use Only <br /> C.-7 I ` /00, q 4 Qa lit° PER IT t lR-0 ttl O C� t <br /> Owner/Authorizad Agent Sian tura Date (Revised 5/20/2\016) • <br />