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PERMIT APPLICATION <br /> BUILDING I MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vo////. 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257,8810 I FAX 425-257-8857 I(E)overeneps(aeverettwa.gov I www.evereitwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> c..1 iN 1-)1 , , <br /> PROJECT SITE ADDRESS: (g, C quo s' r L,- ,,,',-"-----' r-19- PROPERTY TAX#:co'3 q 4'1 0 6c0c)Li,oc, <br /> LEGAL for now construction: Short Plat/subdivision Lot No. (attach copy ot long logal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: \II r\ rY\a 5S...x.rt. a..( (....- <br /> ;.. TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: s/fiw i (el ' (.4, (I - 'PL -s s.....L.,„ <br /> ' ?) <br /> ciri: -.C.,-k,),-L.,"4, ' srATE. Wa— 7IP qc.) <br /> ci. <br /> OWNER PHONE34 9 5 . cii_ i • cf '1,5E5 OWNER EMAIL: <br /> CONTRACTOR NAME: Brennan Heating <br /> CONTRACTOR ADDRESS: sif :Li 4601 S 134th PI <br /> c,r, Seattle STATE Wa 29 98168 <br /> CONTRACTOR PHONE: 206-248-7900 -CONTRACTOR EMAIL: Jairnie@brennanheatirlg.com <br /> . . <br /> CONTRACTOR LICENSE$4(REQuiRED): BRENNHA971R9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 028230 <br /> PRIMARY CONTACT: 0 OWNER p CONTRACTOR 0 OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-248-7900 <br /> Jaimie How CONTACT EMAIL: JaimieAbrennanheating.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building /-: . 0 <br /> Contract Price of Work: $ _ Alit — <br /> Proposed Use of Building: Heat Source: IBTas 0Electric 00ther— <br /> ...- <br /> Buildin• I pe: OSFR-Delached OSFR-Attached GElbuplex 0Multi-Farnily-#of units _ 0Comrnercial [Industrial <br /> Type of Project IZINew OAdOition OfRemodel 21 Repair [DTA, 0Sign 0Sprinkler ODemotitiort °Change of Use <br /> DESCRIPTION OF WORK: <br /> t <br /> r1 63 ez, r <br /> ASSOCIATED <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: Now __Addn Alteration _Repair <br /> #of #of #0, #of <br /> LiSt <br /> Fixtures Fixtures Fixtures Fit Of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> ures <br /> A/C-Air Handling Units <br /> Hew Pump Toilet Backflow Preventer(inside Bldg) <br /> i Forced Air Systems Unit Heater Bathtub Urinal <br /> 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 Gas <br /> Range Hood -Water Heater Other: <br /> i Exhaust Fan Sink(Service/Bar/Mopietc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads . <br /> ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is/rue and correct. Work dons pursuant to this permit must comply with <br /> current fedora& state,and local law. The granting of a permit only authorizes approved work and no deviations thertrfrom.Deviations must first be authorized in writing from the <br /> Budding Official before Ceuta authorized under any circumstance.I urn the owner,or I am cruthoriired by the owner of this property to perform the work for which application os made, <br /> and I corn ry with The State Contractors Law 18 27 RCW and 296.200A WAC, <br /> // <br /> I - . <br /> -II---- <br /> erlAuttiorized Agent Signature <br /> Eafr/ <br /> /af e?1,f, <br /> Date City of Everett Official Use Only <br /> PERIV\ ‘y) D ow <br /> (Revised 9/23/2016) <br />