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09/10/2016 SAT 9: 35 FAX 425 252 1666 CM Heating EJ002/003 <br /> PERMIT APPLICATIONI- <br /> �'— BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER / DEMOLITION <br /> CITY or EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 1(E)averetteps©everettwa.gov I www.evereltwe.gov/permits <br /> (.RIUe.01:RI4,'•ink owl le' se�^ <br /> �►�' }. ': R4.iT..s1te iN»QIMATIi:QN: . <br /> PROJECT SITE ADDRESS: I g 100+11 SW s 4'.4:1 -k9PERTYTAX#: <br /> LEGAL for new construction: Short Platisubdivleton _ Lot No. (attach copy of tong legal description) <br /> CO `I" CT 1�!1F .(RMA'(f1.t3N ' <br /> OWNER NAME: i- "a te i `:, TENANT NAME(If Commercial : <br /> OWNER MAILING AbDRE=3: STREET 11– 'al- 1_00114 Sr SIV #5O <br /> CITY 'G 11 STATE \Ait2/......_. <br /> OWNER PHONE: q E 353 co 3 S"1 OWNER EMAIL: <br /> CONTRACTOR NAME: AAA A 'Audi a <br /> CONTRACTOR ADDRESS: STREET L- ''� SW*� it :A <br /> CITY STATE � ZIP r a _ <br /> CONTRACTOR PHONE: 1 0` :Pi C0 () CONTRACTOR EMAIL:f 1 it h V Circa f R. " ♦ 4")it <br /> CONTRACTOR LICENSE#(REQUIRED:o'f l RJ; LICENSE#(RERED i C1��(671 fl CITY OF EVERETT BUSINESS LIC QUI ) <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) - <br /> i <br /> CONTACT NAME; �f� ,�/ r CONTACT PHONE: L.I.Q . '•9 o5 ) <br /> ��' �f'1e(,`'�1 CONTACT EMAIL; <br /> Existing Use of Building: ' Contract Price of Wor . AO <br /> Proposed Use of Building: Heat Source: CIGas 'lectrIc ❑Other <br /> Building Type: ❑SFR-Detached 1:3$FR-Attached °Duplex ❑MuItI-Famiry-#of Units: Commercial ❑Industrial .._._ <br /> Type of Project; ❑New ❑Addition 0Remodel ❑Repair QT.!. ❑Sign ❑Sprinkler �IIemolltlan CIChange of Use <br /> DESCRIPTION OF WORK: <br /> e)„ <br /> Rap Fle-C-4120.C 'lCc � - IYI �, �o� <br /> l e 1K1,4 fh.Q_, <br /> ASSOCIATED BUILDING/rr���� PERMIT#(if <br /> applicable):�yTl■in <br /> Type of Protect: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration Repair <br /> Fixtures ft <br /> List of Fixture. F/Xit°r a List of Fixtures a°f List of Fixtures °r List of Fixtures <br /> fixtures Fixtures _ <br /> NC–Air Handling Units lieat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systeme Unit Heater Bathtub Urinal -,Gas Piping Boiler - 'Lavatory(Wash Basin) Drinking Fountain <br /> ' Water Heater Refrigeration Shower Floor Drain <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 Gee - <br /> Range Hood - tFq,Mt Water Heater `' `` .,, `'" '• Other: <br /> Exhaust Fan _ Sink(Service/Bar/Mop/etc.) Other: <br /> - <br /> Number of Heade <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein Is true end correct.Work done pursuant to this permit must comply with <br /> current federal,slate,end local taw. The granting of a permit only authorizes approved work and no deviations therefrom,Deviations must first be authorized in writing from the <br /> Building Of/iclef before being authorized under any clroum stance,I em the owner,or I am authorized by the owner of this property to perform the work for which application Is made, <br /> and I comply with the Slate Contractors Lew 18.27 RCW end 298.200A WAC. <br /> / / City of Everett Official Use Only <br /> / i .ArAZ .. Ian oct <br /> ®o <br /> Owner/ <br /> Authorized Agent Sign tura Date (Revised 5 0/2078) <br />