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Nov. 16. 2012 11:14AM EVERGREEN STATE HEAT & AC .L222 p <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Evelelt, WA 08201 425-257-8810 FAX 425-257-6857 www.everettwa.oig <br />... nc,.^MAAMTOAPM <br />POOS PERTV T' <br />P RMIT0 <br />sneADDRESS: 34i t{I.v(ia5 <br />� � <br />LEGAL for ntnv oonsl,wtanShot PlausubdNslon Lot Na_ (attach copy o11rNg legal deWplion) <br />t1�pL) IJ Lt IIFvwI C�rR-�l_ <br />r� -b <br />PhonorE-mallC\�r7 �8 <br />OWNER <br />Arldress 3 �t `} N�-Y 5 <br />C,IylslatNZip <br />APPLICANT:_ Omler _O+mees Agent ,ji Canhaclor _ Conlractces Anent _Tenanttmnnp,a,nr•:reerel.,,r,,era hcn ve ».c•rto ao eoAn Na IPKa) <br />CUCR61tGQN STATE ,S099T ItAVAC. L A I Lic. N EVI50fSS C'7- 24 T COE Bus. LIC. N b0'1q <br />CONTRACTOR <br />Address 'It-ZD ?Adt4c- AlUF-EUelkrlT.WA 99201 Phone!Emil020 252-i114 <br />T ENA T BUSINESS NAME <br />CONTACT FOR PERMIT <br />ti2S—�5� -31fy Kc'' <br />AOI/An)Cuo Dt:-o(W <br />FrwnelE-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE of WORK <br />Existing Use of Bulli ing COh'1r" I dy).c1 A� HEATSOURCE: <br />rYrwr+-W"Lu.� �YO CIIrbJGr Gas r- Elaarfc Other <br />Proposed Use of Building <br />Buildinglypo: Single Family _Duplex_Towulmuso ^,Mulfi•Family K Commercial <br />,_,_ <br />Type or project: New Addition Remodel 1C Repair T.I. 51 n 5 rinkler_Demollllml_Chall o of Use <br />DESCRIPTION OF WORK (addhlonals pace provided on the, back): V 5 LIJ G f •fgT/lU G <br />p LJ AlAL� koZA(-t.o v <br />z. UN (T O-M-CA5 I <br />�i�tvyi JENrIN� <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typegl Prniecl: _Nbw_Addu ___AIImallon_--Repah <br />7ypeol Plolecl: __New_Adda _Allerallon_Rapalr <br />Shmv Number N)ollixfures <br />Show Numher(R) of fixtures <br />A/C -• air handling units <br />I <br />Tollol <br />m <br />Forced airs slas <br />Bathtub <br />a <br />Gas lg <br />I.avalo wash basin <br />Water healer <br />Shower <br />Gas file lace <br />Kitchen sink 8 disimsal <br />Gas range <br />Dishwasher <br />Clothos cler <br />Clothes washer <br />Range hood <br />Water healer <br />Exhaust fan <br />Sink wrAwlbarlmoplelc.) <br />Beal pump <br />Backfiaw prevenier <br />_ <br />Llmt healer <br />Urinal <br />Drinking Fountalh <br />Boller <br />Refrigeration <br />Floor drain <br />Woodslov0 <br />I Grease trap <br />Ducting <br />Roof drains <br />Olhor <br />Medical Gas <br />SPRINKLER <br />I SUPPRESSION SYSTEM <br />other. <br />Number or Heads' <br />Other: <br />I he,aby cedbry Ihsl I Pave lead and esamhed this BppAcalkn and Lnow Vie came robe bve and contKA Al pmvisims of lava and oN'nanoea govemhg this llpe of wink vA be WMPhed <br />wan a'nemer cpetlWed hereh or notlTa granting of a penal does Dot Presume la gNe aulhcnty 10 violate or anal the protndon at any other stale or lout 4+r legunhng conslNown <br />1T6t I um aumodred by the o+mor or mil PropnU'to perform me vvod: for efi411 eppkalkn is made and I campy v.M the State C.whacims Law 19.27 SCV1 and 296.200A WAC. <br />l2— <br />OlvnerlAuIhorIzed A Signature Data (Revised 0012) <br />