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10/13/2p16 TxU 13: 22 FAx �25 ?5? 1666 CM Heating f�006/048 <br /> PERMIT APPLICATION <br /> BUi�DING / MECHANICAL/ PLUMBING / SIGN l SPRINKLER/ DEMOLITION <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREEI', EVERETT,WA 96201 <br /> (P)426,257-BB10 � FAX 425-2b7-8857 �(�)everettep�(�everetlwa,gov � www,evereltwa.flovlpermits <br /> Blue t�t g���k I�ik Qrf! p�e��e PRC�J��T SITE� 1 F�I�IVIpYION <br /> PROJECT SfTE A�DRESS; PROPER�'Y TAX#: <br /> LEGAL tor new const�uCtlOrl' Short PlaUsubdlvlsion Lot No.� (attach copy oE(vng legal daecrlptlon) <br /> � CON"�AGT INFQRM/�'I'IbN <br /> OWNER NAME: � ' <br /> �G TENANT NAME(If Comm�rcial): <br /> OWNER MAILING ADDRE35; BTREET 1� <br /> emr BTAT� �l/, �' YIP � �j <br /> OWN�R PHdNE: CO�� � � OWNER EMAIL.; <br /> CONTRACTOR NAME: � <br /> CONTRACT�R ADDRESS: aTaE�r � <br /> cFrr B7AT� �,(� ziP D�� <br /> CONTRACTOR PHONE: � CONTRACTOR EMAIL: ���N <br /> CONTRACTOR LICENSE J�(REQUIRED):� �� � CITY OF EVER£TT BU91NE5S LICENSE�I(REQUIRED): QQ�� <br /> PRIMARY CaNTACT; C] OWNCR ,CONTRACTOR L7 OTHER(Please Speclfy)� _ <br /> CONTACTNAME: �����i� coNTACTPHONE: a —Q� p <br /> CONTACT EMAIL; .�'� C(��,�� � ,1-� <br /> . � .' . .l�►. �M�, '.4�1�:�..M��� � �I{�� �. , , , � <br /> Exfatln Use of Bulldln : Contract Prlce oi Work: $ � <br /> Pro osed Use of Bulldin : Heat Source: as DElectrlc Opther <br /> Bufidln e: �,EFR-Detached ❑SFR,Attached ❑bu lex ❑Muft1-Famll -#of Units: ❑Cornmarcial ❑�ndustrfal <br /> T a of Pro ect: �New ❑Addition ❑Remodel ❑Re alr ❑T.I, �5i n ❑5 rinkler ❑Demol{tlon ❑Chan e of Usa <br /> DEBCRlPTION OF WORK: <br /> � <br /> A880CIATED BUILDING P RIUI�T# If a Ilcable : <br /> ,. <br /> %'�����#4�,f���,�' '''' �'';' � ''� ?�' ����� ,. , �6, , <br /> �' �;- 4�' �LI ATIbN <br /> Typa of proJact: _New _ Addh _Alt�ratlon Repalrl Typo of Profect: New Addn Alt�ratlon Repalr <br /> #of L/sf o/Flrfurea �°} � �°� � �A af <br /> �fxfurea Flxtures ��Sf Of Flxlurra Llst QrFlxfures L/st of Flxfuraa <br /> Flxfures Plxfuns <br /> AIG–Air Handl(n Units Heat Puirp Toilat Backfl�w Preventer Insfde Bld <br /> Forced Alr S stem5 nit Fieater Bathtub Urfnal <br /> Gas PI In Boller Lavatory Weah Basln Drinkln �ounlain <br /> Water Neater h�efrl eretion Show�r Floor Draln <br /> Gas Flre lace Wood 5tove Kftchen Slnk 8� Dls osal Gre2se Tra <br /> Gas Ran e Ductln Dlshwa9her Roof Dralns <br /> Cloihes Dr er Hooku s Other, Clothes Washer Medlcal Gas <br /> Ran e liood Waier Neater Other: <br /> Exhauet Fan Slnk Servlce/6ar/Mo /efc. Other. <br /> ^r°�"�'Yi+?!.� 1 �<:' �,i ,I�,,F. 'i: ''��� <br /> Num er o �a a <br /> ACKNOWLEDGEM�NT.-I h�ve revlev�d thls eppf/cauon and vaifb�m the rnformatlon confafned hereln 1a rrua end oorracr. Wortr dane pursuant ro thls permtr must oomply wuh <br /> current feaeral,stsle,and local few, The pran�lnp vfe permlf only authorizes approvetl work and no dev�atlons the�elrom.Dev/allons must flrst be author�zedln wrrtrng lrom tne <br /> Bu(IdJng�fJiclel6efore Deing eulhorized under any circums�ance.I em the owner,or!em author�zed by fhe ownsr o/thls praporty to p�Norm 1he wark far whlch eppllce!!on Is made, <br /> arrd f comply wifh the Slate Conrractarslew 1g,27 RCW and 29s,200A WAC. <br /> �Clty of Everett Ofllcra!IJse Onfy <br /> � (� /n PERMIT#� I � ' O%� <br /> ' V� ,� �l�[ � <br /> �wnor/Authorized Agant Slpn turo Da e (Revls�d 6/2 01BJ <br />