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Jan. 8. 2016 10: 50AM EVERGREEN STATE HEAT & AC No. 6041 P. <br /> •ERMT APPUCAT O• <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa,org <br /> SITE ADDRESS: Z7- <br /> r 'PROPERTY TAX 11 - PE" IT# ,_.07-1—G <br /> LECQAL for new construction: Short PlaLIeubdivtslon _ Lot No, (attach copy of long legal description) <br /> ;oWNER A( 6fA4 -) Phone/E-meil ( 4-ffZS--) ZSZ—ori �i <br /> 'Address 322 K �D-4" _. ■.-w! City/State/Zip &..71/--/Z...6-..- lz/I /' Z03 --- - - <br /> _ <br /> •APPLICANT" Owner Owner's Agent Contractor Contractors Agent _Tenant(must provide atetterorconsantfrom the owner toaswork Inth space) <br /> CONTRACTOR E u.pfZ,L.-'-to 6-k, (-I A. a A6 Stale Llc.# - . L4 - O22_ Cit Bus. LIG.#p• 10 r <br /> ' (1 (r.1, ) 252 -3 1 r-o <br /> Address Z.1 l rid-` C. Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> VEK! SALO (ti-zSJ 062.--__.3//1 <br /> __ Phone/E-mail )p.A CA / _i/ ., MM <br /> BUILDING PERMVMIT APPLICATION CONTRACT PRICE OF WORK ' `-sa.7‘ �i- • <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas>(.4 Electric Other . <br /> Building type: )4,Single Family Duplex Townhouse Multi-Family Commercial <br /> Type o>proJect: ^New _,Addition Remodel. Repair T.I._Sign_S.rfnkier_Demolition Change of Use <br /> DESCRIPTION OF WORK(addlltonel space provIded,on the back): <br /> MECHANICAL PERMIT APPLICATION P UIVIENG PERMIT' APPLICATION <br /> I <br /> Type of Project: New ,Addn _Alteration Xr:epalr Type of Project: flew Arkin _Altera tion Repair <br /> Show Number(fl)offbetures Show Number(4)of fixtures <br /> A/C-air handling units Toilet <br /> 1 Forced air systems _ Bathtub <br /> Gas piping havatorylwash basin) . <br /> Waler heater • Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> 1 Gas range I_ Dishwasher _ <br /> Clothes dryer f Clothes washer <br /> Range hood Water heater <br /> 1 Exhaust fan r <br /> Sink(service/bar/mop/etc.) <br /> 1 Heatpump Backfiowpreventer <br /> Unit heater Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration Floor drain • • <br /> - <br /> 1 _Woodstove Grease trap <br /> I Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM J Other: <br /> Number of Heads _ Other: . <br /> I hereby certify that I have read and examined Ns spptIcelon and know the same to be True and correct.AO provisions of laws end ordinances governing Ibis typo of work wlll bo compiled <br /> with whether ape dried herein Dina The granting ora permit does not presume lo- a aulhorny to violate or cancel the provision of any other state or local law regulating construclon <br /> That I em authorize,by the o •;-r of this :open),to perform theWOrk forwhlch application Is made end I comply with the Stale Contractors Law 16,27 ROW sad 206.200A WAG. <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />