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Jul. 6. 2016 2 : 23PM EVERGREEN STATE HEAT & AC No- 7428 P. 1 <br /> SPERMIT APPLICATIOO <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425257-8810 FAX 425-257-8857 vA W.everettwa.0rg <br /> SITE ADDRESS; PROPERTY TAX H P MIT!, <br /> LEGAL for new conslruclien: Snort Plat/subd(vlslon Lot No. (attach copy of long legal daGCrlplion) <br /> OWNER 05 /g /02 PhonelP-mall C�ZS� <br /> Address / City/Stelelzlp , g� <br /> APPLICANT; Owner _Owners AgentContractor _Conlraclor'sAgeni ,_„_,Tenant(mumprovlaeal9uerorconsentrromthe owner todowork InthEzpace) <br /> CONTRACTOR t C $ Slate Llc.#G� Ci(y Bus. Ltc.# 0 <br /> AddreSS Phane/Email <br /> TENANT BUSINESS NAME CONTACT POR PERMIT <br /> Phone/F=mall <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family _Commercial <br /> Type of project: _New Addition Remodel . Repair_T.1._Sign_Sprinkler_0entolition_Change of Use <br /> DESCRIPTION OF WORK(addlflonal space provided on(tieback): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of project: —New__Addn —Alteration—Repair 'typo of Project: ___,New__Addn Altaratlon_Repair <br /> Show Number(#)o/fhetures Show Number(#)offixfures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fire laoe Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water healer <br /> Exhaust fan Sink(service/bar/mop/etc. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boller Drinkinu Fountain <br /> Refrigeration Floor drain <br /> Woodslove Grease trap <br /> Ducling Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby cerwy ipsl I have read and examined[his appGeaGon and know the seine to be true and correct.Aft prooislons or laws and ordinances governing Ihla type of work will bo complied <br /> with whether specdled herein or nol.The granting of a permit does not presume to gtva authority to violate or cental tha provision of ahy other stale or loeal law regulating construction <br /> That I am authofize by the owner or thla y to perform tho work for whIch appllcstlon Is msde and I eamply whh the Slate Contractors Law 18.27 RCW end 296.20DA WAC, <br /> '7—�o —16 <br /> Owner/Authorized Agent Signature Date (Revised 312013) <br />