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Dec. 9. 2015 1 : 54PM EVERGREEN STATE HEAT & AC /1 (�((Y11ONo, 5844 P. 1 <br /> •EHT AUPL CA * <br /> BUlLDVNG/fVl[ CHA CALIPLUMBING/SIGN/5FRANKLER/DE OUT ON <br /> CITY OF EVERETT IPE Milli' SEP.VICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8310 FAX 425-257-8857 www.everettwa,org <br /> SITE ADDRESS: / 1, / PROPERTYTAK# P> RNuT# Ll I 1 <br /> LEGAL for new conelrtidion: Short PlaUsubdlvisfon ��( Lot No. (attach copy of long legal description) E <br /> OWNER 1 Akoto W4 (I-0Phone/E-mall lZs9 — T4/6q <br /> Address City/Slate/21p t/✓f/&14 -C _ �o eZ J <br /> APPLICANT: Owner Owner's Agent Contractor _ConlractorsAgent ^Tenant(mit provtdeatelleroroonsenl from the vWerloco wcrklril2e eI <br /> CONTRACTOR GUC12.6C2L—Z tom) (*ATI A L_Slr3ie l.Io.#GXERCACity Bus. LIC.#0Of`15 ' , <br /> r � a� <br /> Address 24.i 4a-CC I hone/Email 252-311'4 <br /> 3lt _ _ - _ <br /> TENANT B SINESS NAME - 'CONTACT FOR PERMIT ' <br /> Kcti15i L0 (Li'zsJ ?CZ-3/"J <br /> Phone/E-mail i , eb. . AI_ ' _ L -/ .__ -E <br /> •)bIJI�,®IIIG PERMIT APPLICATION CONTRACT PRICE OF WORK O. <br /> Existing Use of Building. HEAT SOURCE: <br /> Proposed Use of Building Gas EleclrfcK Olher . <br /> Building type: •Single Family —Oupiex Townhouse ,Multi-Family _Commercial <br /> .e of pro act: New _Addition Remodel . Repair T.I. Sign^Sprinkler demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the bank): <br /> 106 ( .—(Z) Z cftcs$ 4- 4 tom`",-' <br /> MECHANICAL PERM T APPLICATION RUM/BUNG PERWT APPLICATION <br /> Typo of Project: TNewljlddrt )(Alteratton Repair Type of Project: _New_Addn _Alteration Repair <br /> S/row Number(#)of fixtures Shove Number(#)of fixtures <br /> NC–air handling units Toilet <br /> I Forced air systems Bathtub <br /> Gas pipin• Lavatory(wash basin . <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&dis.osai <br /> J Gas range J Dishwasher <br /> Clothes dryer Clothes washer _ <br /> • Range hood Water heater <br /> Exhaust fan • _ Sink(service/bar/mop/etc.) _ <br /> 1 Heat.ump _ _ Backflowpreventer <br /> Unit heater JUrinal <br /> Boiler Drinking Fountain <br /> Refrigeration I Floor drain <br /> Woodatove Grease trap <br /> Ductin• Roof drains <br /> _Other Medical Gas <br /> SPRINKLER/SUSSIOVI SY's u ISM_ Other; <br /> Number of Heads I Other: - <br /> I hereby certify That I have read and examined thia eppicatlon and know the acme to be true and correct.All provialona of laws and ordinances governing lhla typo of work Will be cornplled <br /> with whether ape dried herein or not.The granting ors permit does not presume Io.gNC authority to violate or cancel the provision or any other state or local law regulating construcifon <br /> Thel I sm authorized by the owner of pro rty to perform the viork for which application to made and t comply with the Stale Contractors Law 18.27 RCW and 2ee,200A WAC. <br /> 00 <br /> ‘ .(:,"\-.-\_ A — "—/5 4 (1-D i ........r, <br /> .. <br /> ownerfAuthortzed Agent Signature Data (Rev/sed 3/2013) <br />