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May- 24. 2016 1 : 41PM EV*EEN STATE HEAT & AC No- 7114 P. 1 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedai-St., Everett, WA 95201 425-257-8810 FAX425-257-8857 www.everettwa.org <br /> SITE ADDRESS; PROPpRrYTA){# IP^R�T <br /> LEGAL for new construction: Short Plal/ailbdlvislorL Lot Nom (attach copy of long legal dlelseript(on) <br /> OWNER Phoney-mail T� 3t11--7— /` <br /> Address Z V C1ty/51ate/Zip " <br /> APPLICANT,_.,Owner "Owner's Agent LContreclor Contractors Agent _Tenant(mualproVIdealar(erolconsenifrom veovrner(odoWork Inthe spacje) <br /> CONTRACTOR CU 7� 'tJ C_ P�4' (Z State Ltc.#ry p City taus. Lie.#pts 1 <br /> �¢2 ) —311 <br /> Address ?— 'z i �L Phone/Ercall <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �-1J <AL6 �qZ -J 06-Z <br /> PP1one/E-ma(i <br /> BUILDING PERM)IT APPLICA7 110M CONTRACT PRiCE OF WOR K���,'n M' <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building (3as Electric oth®r <br /> Building type: 4 Single Pamiiy _Duplex Townhouse ,_Multl-Family _Commerclal <br /> Type of project: New _Addition �Remodel._Repalry T.I. Sign_Sprinkler_Demoliiion_Change of Use <br /> DESCRIPTION OF WORK(eddltional space provided on the beck)' <br /> (:�,C r BAS ��rZf.�lkC�L <br /> MECHANICAL6�1�)t�M111 APPLICATION PPLUMBIfI�� PERMIT APPLICATION <br /> Type of project; _.New Addn --Alteration--Repair Type of Project: ,_,_New_Addn ___Alteration_Repair <br /> Show Number(#)offxtures Show Number(4)offlxfures <br /> A/C—air handling units Toilet <br /> Forced alr systems Bathtub <br /> Gas 2[ping Lavator wash basin) <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dls osal <br /> Gas range Dishwasher <br /> Clolhes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust Earl Sink (service/bar/mop/etc.) <br /> Heat purr Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refd arallon Floor drain <br /> Woodstove Grease frap <br /> Ducting Roof dralns <br /> Other Medical Gas <br /> 5 P R I ER/ SCPPRESSIOM SYSOther: <br /> Number of Hands Other: <br /> I hereby centry(hal I have read and examined(his appice(lon and kpovr the same(o be[rue and correct.Ail prom.51one orlawe end ordinances governing this lype orwork will be compiled <br /> with whelher apectiled heraln or not.Thegrsnling ora permll does not presume tagtva aulhor(ly to vlotete or canoor the provielon of any other slate orfoca(lav/regulating construction <br /> 'that i am author[zed ay Ih tuner or Ihla properly to rm the work(orwhlch application le made and I comply vrfth(ho Sia le Contractors Law 18,27 RCW and 296.200A WAC. <br /> owner/Authorized Agent 5lgnature Dale J (Revised 3/2013) <br />