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11/10/2016 THU 15:39 FAX 425 252 1666 CM Heating U003/003 <br />PERMIT APPLICATION <br />OL BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET. EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-267-8857 1 (E) everettepe[$everettwa.vov I www_everettwa.gov/permits <br />Brut or Bun k Ipk 1pnl ttege:e M0 00T IITO INF6 MATIGN <br />PROJECTSITEAODRESS; dab G C&ryLe(24e" PL- <br />PROPERTYTAX#: <br />LEGAL for new construction: Short Plat/subdlvIsion <br />Lot No,_ (attach copy of long legal description) <br />• • ' �calwtA�� K�rFpainnsYlaN <br />OWNER NAME: <br />TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />Ct{'yLr�(� PLC <br />CITY <br />OWNER PHONE., �rj qa3 ' 40 <br />STATE <br />OWNER EMAIL; <br />ZIP 3 <br />CONTRACTOR NAME; 1 <br />' <br />CONTRACTOR ADDRESS: STKEEr <br />CITY <br />STATE <br />ZIP <br />CONTRACTOR PRONE; <br />CONTRACTOR EMAIL: <br />� <br />CONTRACTOR LICENSE #(REQUIRED): �� n <br />CITY OF EVERETT BUSINESS LICENSE PIREQUIRED): <br />g <br />PRIMARY CONTACT; ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: r CONTACT PHONE: <br />CONTACT EMAIL; <br />Existing Use of Building: <br />Contract Prlce of Work: $ t�dQ <br />Proposed Use of Building: <br />Heat Source: CIGas leetrle <br />❑Other <br />Bulldin T e: FR-Detached ❑SFR-Attached ❑Du !ex ❑Multi-Famlly-# of Units: ❑CDmmerclal G71ndustrial <br />Type of ProJed [New DAdditlon Mernodel ❑Repair <br />DESCRIPTION OF WORK: <br />rLh tip/AID <br />ASOOCIATED BUILDING PERMIT #(if applicable): <br />❑T.i. ❑SI n 13Siorinkler ❑Demolition <br />OChange of Use <br />Is WIN . •, f <br />Type of Protect: _New _ Addn , Ziteration _Repair <br /># of Ulst of Fixtures 0 of <br />Flxtares fixtures Llat of Fixtures <br />r r 7� iT .. �� .� ., i : .i. It 0 ff'1! • N. <br />.New <br />Type of Project: Addn^ _Alteration `Repair <br /># of T # of <br />Fixtures �� 4f Fixtures Fixtures List of Fixtures <br />A/C —Air Handling Units <br />Heat Putn <br />Toilet <br />Backflow Prevanter Inside 13id <br />Forced Alr 5 tems <br />nit Heater <br />_, .__ _ <br />Bathtub- <br />Urinal <br />Gas Piping <br />Boller `' ' <br />Lavatory Wash Basln <br />Drinking Fountain <br />Water Heater <br />Refrl oration <br />Shower <br />Floor Drain <br />G89 Fireplace <br />Wood Stove <br />Kitchen Sink & Dls osai <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Dralris <br />Clothes D er Hookups <br />Other: <br />Ciothea Washer <br />Medical Gas <br />Ran a Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc. <br />other: <br />I�' 5 � ti• 7 .•Inr I .•A. <br />Num er of Heads <br />tCKNOWLEDGEMEMT I nova reviewed this appficetion and confirm the information contalned herein is true and correct, work done pwauant to this permit radar comply with <br />:arrant federal, atefe, and /oval law, The granting of a pen» ft oMty authorizes approved wo►k and no deviations therefrom, D®viat/orla must first be authorized in writing from the <br />3uilding Of clef before being authorized under any circurrratence, I am the owner, or I am authorised by the owner of this property to perform the work for which application is made, <br />rnd I comply wilh the State Contractors Law 18,27 RCW and 296, 2o0A WAC, <br />City ofEvereft Official Use Only <br />pEF2Ml� <br />r � <br />Revised 512012016) <br />