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Jan. 13. 2016 2: 34PM EVERGREEN STATE HEAT & AC No- 6079 P. 1 <br /> OERNT APPUCATD* <br /> CITY OF EVERETT PERMIT S5RVIGES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8510 FAX 425-257-8857 www.evereftwa.org <br /> SITEAbDRESS: � � ILZ��PRO <br /> P�RTYTAt(ft PER I <br /> LEGAL for nets constroctfon: Short PlaUsubdlvfalon Lot No• (allec�h copy of long lladal descrlptlon) <br /> OW1�IR /Q 1�V Phone/E-mall <br /> Addfess `f City/Stale/ZIP <br /> APPLICANT; Owner _Owner's Agent --kConlracior _ContractorsAgent —Tenant(mwtprovldoafeuarerocnsentfromtheownertodoworkinTie sp—) <br /> CONTRACTOR �VC� 1= c' S[ate Lio,#� = (} 21'J CiLyBus. LIc.#Da- <br /> t 252 -3 11,4 <br /> Address �('� /{ �� hone/Small <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> r!CN '<;�Lo C e O-O'V <br /> Phony/E-mallKe-14r <br /> BUILDING PERMRT APPLICATION CONTRACT PRICE of WORK <br /> Existing Use of Building HE5ATSOURCE: <br /> Proposed Use of Building Gas-y— Electric Other_ <br /> Bulld[ng type: Single Family Duplex Townhouse Mulll-Family Commercial <br /> lype ofproject: _New _Addition _Remodel. Repair.T.l•_sin Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional s ace provided on the back): <br /> �(h�rr�Gc qD°1a rm 5 <br /> MECHANICAL PERt1 IT APP ICATHOW M13UNG PERMIT APIPLICATION <br /> Typo of project: ,_Naw_Addn -_Altaratlon__Repair Type of Project; _New Addn AlteraLtap_Repair <br /> ShOV/Number(#)Off/x[ures Show Number(#)oftlxfures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas pipingLavatory wash basln) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink A disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sinl< servlW1bar/mo /eto_) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woods[ove Grease trap <br /> Ducling Roof drains <br /> Other Medical Gas <br /> I�'LZIR9ttt LER/SUPPRC-65100 SYSTIEM Other: <br /> fVumber of Heads Other: <br /> hereby cordry that I have resd and examined[hfs appHCsllon and know rhe some to ba true and correct,All provisions or Nwa end ordfnances governing[his type orwork will be complied <br /> wlih whether specified herein er nol.The grsnting of n permit doas not presttmo la gtve aulhodly to violate or cancaf the provialon of any other state or local few regulating construaron <br /> LTfualla4mEwlhorlyLheowneror opbrty ro parform Lha work for witlch applics[ien le made and I comply with Lha Stale Contractors Law 19.27 ROW end 2s6,20oA WAC. <br /> OwneAgent 31gnaiure Date (Revised 312013) <br />