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Sep, 30, 2013 9: 29AM EVERGREEN STATE HEAT & AC No- 8493 P. 3 <br /> 0 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St„ Everett,WA 98201 -425-257-8810,FAX 425257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 ANI TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX q PERMIT 9 <br /> o /?CI - a7 <br /> LEGAL.for new construction: Short Plat/subdiviafon Lol No. (attach copy of long legal descriplion) <br /> Z�g - 1 <br /> OWNER (306L..�(5 I'honeJE,mall 2S 3 Lf <br /> Address c)( U(f Clty/slate/Zlp Gui]�TC <br /> CONTRACTOR IL&I Lic.# EVC�74W5507--Z - <br /> (� <br /> Address 2,L2p Lek(C, PhonelEmal <br /> TENANT BUSINESS NAME CONTACT 3R PERMIT <br /> kLl�.i �t-D <br /> Phone/E-mai(q,S) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK C�11 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ other <br /> Building type: -�/- Single Family Duplex_Townhouse _Multl-Famlly _Commercial <br /> Type of project= New _Addition _Remodel Repair_T.I._Sign Sprinkler_Demolltlon_Change of Use <br /> Description of Work(additlonal space provided on the back): <br /> Have you started working without a permit? YES NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_--_Addn _Alteration_Repair Type of Project: _New_.Addn _Alteration_Repair <br /> Show Number(t#)of flx[ures Show Numher(#1)of fixtures <br /> C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory wash basin) <br /> Water healer Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dtyer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink service/bar/mo /eta <br /> Heat pump Backflow proventer <br /> Unit heater Urinal <br /> Boller Drinking Fountain <br /> Refrl eralfo6 Floor draln <br /> Woodstove Grease trap <br /> Ductfng Roof drains <br /> Olher-_ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other; <br /> Number of Heads Other: <br /> I hereby cenify that I have read and examined this application and know the some to be true and correct.All provisions of laws and ordinances governing <br /> this type of work wjll be complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or Cenral <br /> the provision of any olherslata or local lawregulaling construction or lho performance of construction,The(I am aulhonzed by the owner of this property <br /> to perform a rk ror which icalion is made and I comply wflh the Slate Contractors Law 18.27 RCW and 296.200 WAC <br /> owner/Authorized Agent Signature Dale (Revlsed 2/2019) <br />