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11/28/2016 MON 10: 09 FAx 425 252 1666 CM Heating ¢j002/003 <br /> PBUILDIN�/ MECHANICALS PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT WA 98201 <br /> (P)425-257-8810 IGFAX 425-2578817 1(E)evereltep66avere <br /> ttwa.gov i wwwli.everettwe <br /> ,govlpermlts''1-�l= u• ;;��.� � j ���1';hleuie ,` , . .',_a:PRO Eco,-..I , . r M::TION '-,!,.,;; ,:‘,A:: :.",'!.. . '.rPROJECT SITE ADDRESS; tPy <br /> PROPERTY TAX#: <br /> LEGAL for new oo <br /> rlatructlon: Shotti Plat/subdivision <br /> Lot No. (attach copy of long legal doecriptIon) <br /> �'' ' "`'•CO 1 C 11' 1RQ`R' <br /> OWNER NAME: Pr .'V li 0 # ire <br /> TENANT NAME If Commercial); <br /> OWNER MAILING ADDRESS; STREET q r36 t e <br /> CITY 1 1iLa2r \mei <br /> OWNER PHONE: if, STATE Z� I�.�3. <br /> (o '�op Zia <br /> OWNER ENTAIL; • <br /> CONTRACTOR NAME; dIL l , r i 1 <br /> CONTRACTOR ADDRESS; STREET 1 t2 <br /> e, ofat. 01, _ dr .....„, <br /> CITY - ii`/L <br /> CONTRACTOR PHONE; Lia �S STATE zip • ;20 i <br /> �� CONTRACTOR EMAIL; • • r -� <br /> CONTRACTOR LICENSE#(REQUIRED): J ��'j� <br /> JI '4 el 17�1r1 CITY OF EVERETT BUSINESS LICENSE MRE4UI 11[ ' <br /> PRIMARY CONTACT: Q OWNER <br /> :::/ ONTRACTOR ONTRACTOR ❑OTHER(Please Specify) ‘111.1111111111111w' <br /> CONTACT NAME; <br /> i <br /> �� p c n CONTACT PHONE: ag0 ..4 <br /> O /I f r CONTACT EMAIL:Yiettp42.1ttlAi 0,.(4 -f e <br /> lXl1LD,*O:P1E- <br /> Exlstln. Use of Bulldin,: <br /> Contract Price of Wor ;$_21500 <br /> Pro osed Use of 6ulldin <br /> Bul os T s �:� Heat Source: +arc as ❑Electric le Other <br /> SFR-Detached ❑SFR-Attached ❑Du•lex ❑Multl-Famll <br /> t e of Pro ec. Mew ❑Addition ❑Remodel []Repair ❑T.I. Units; Commercial CTlndusfrlai <br /> 3ESCRIPTION OF WORK: C1Sign OSprinkler ❑bemolition ❑Chan a of Use <br /> iffat <br /> title.-6.0-pacti pic-taki re-fmn ar( duas 5upplyi. I Avtpsfin. s-kii gts')17Le -hryt. <br /> ISSOCIA ov <br /> D BUILDINGatNir4ift limn, /626'ti -G r, <br /> Addn ..wiz ,.''i:',0:: , "r.';';•;. <br /> YPe of Project: New P��lN1B �!li ° 1' <br /> alteration Repair <br /> ' ' 4`pl* r�''� P,, r �, b�': <br /> #of a0f <br /> =/x[urea <br /> LisOf F�r[urea L/af of pill,. • #of <br /> Fixtures Retiree Fixtures of <br /> AIC—Air Hendlln. Units �Heat Pump F/xlures <br /> Forced r S tams Toilet <br /> Unit Heater Backflow Preventer Inside Bid: <br /> Mill Gas PI•In• Min Roller �Bathtub _ <br /> - _ Lavato Wash Basin Orinkin. Fountain <br /> Mair _Refrl.oration Shower <br /> Emini_` _ - ` Wood Stove -Kitchen Sink&Dis.osai _Floor Drain <br /> Clothes D er Hoolcu•a `Ductin. Dishwasher <br /> MIN Cane D IMO Other: MINClothes Washer Roof Drains <br /> _ ; Medical©as <br /> r Sink Service/6 EI NMI Other: <br /> _ � Service/Bar/Mo./etc.lett. �Other: <br /> Num•ero Hews <br /> MIIIIMMEIMIN <br /> kNOWLEDOEMENT:I have reviewed this application and confirm the Information contained herein Is true and correct.Work done pursuant to thia permit must comply with <br /> 'ant federal,state,and local law, The granting of a permit only <br /> authorizes approved work end no deviations therefrom.Deviations must first be authorized In writing from the <br /> 'ding Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> 'I comply with(he Slate Contractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> /'PERj <br /> a 0,i 1 / <br /> f /,oLa.g �t ( - No <br /> t r/AuthorlYed Agent Signature <br /> Date (Revised 9/33/2096) <br />