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Oct, 5, 2015 8;49AM EV GREEN STATE HEAT & AC No,5357 P. 1 <br />ER11�1� �►��Ll�AiiO� <br />BUILDrNG/MECI-lAI�1CAL/PLL�N1��i�C/�SIGIV/SPRIi��rCLER/DEIIIIOLI7'IOfV <br />C17Y O� EVEI��7'T' P�RIV'll�' S�RVf��S <br />3200 Cedar St., Ev�rett, WA 98201 425-257-8810 FAX 425-257-8857 www.everetfwa.org <br />IT� AppR�SS:J � n � <br />[�7 <br />L�GA[. for naw copslrucllon: Short P1�Usubdivlslon <br />owN�R Il �..dr�u�d��> l�t�T. /:�Il�lli <br />1'I�LICANT: _ Otvner _ Owners Agonl <br />CON7f�ACToR <br />r�ss <br />�UILDING PER[Yl1T l�f'PLICATION <br />or <br />peRnr rax � <br />Lol Na. (atlach copy of Iong le�al descfipPfon) <br />Phone/E-mail � ��) Z— <br />Clry/SlalelZlp (r��J G(,{,�-, g � �� <br />Corllractors Agent _ Tenanl (mu:l provldo a lei(er oi conse�l►rom me aynef � 6u work fn tha apacr) <br />� f� (�_ �State Lla # <br />� 3 I i �.c <br />Ci(v Bus_ Lic, �t <br />�PhonelEmail <br />coN'rt'ac� �o�t p�l�Mrr <br />Ke� �w C �zs� �2 �fiy- <br />Pflone/E-mafl p���-�Gh'IG�C. � <br />GON7FiACT PRIC� O� WO}�K 3,SQD, -� <br />�xisting Use of Building NEAT SOU���: <br />Proposed Use of Buifding �as Efeccric cJlner <br />�ulldfng type: _ Single �amily _ Duplex JTownhouse _ Mulll-Famlly ,,,� Commercjal <br />Type of pro�eci' _ New Addition _ Remodel .,_, Repalr_T.l, �Sign,.,�,,,SPrinkler_Demolltlon_Change of Use <br />d�SCRIPTION O� WORK (sdd�Nona� space provFded f�a back): <br />�!-�cwc�� ��c.-�%55 �-Ge,� h� S�sT�- �r--� �2Dr�� �}-r?� <br />� � U� <br />�b, i�l� cT i5 1.�J�C.�... �Ni. ���) D►J �ST-�►O� D`� ��_������ � <br />rVI�C�S1A,1f�1��1L ��RM13' 61P�LIC.q'��OA� ��.UME3I9�lC PEt�M�� AP�L���,710{�d <br />e of Projact; _Nev��ddn ,�Alteraflon _Repafr <br />ShawNumber(#J offixt�res <br />A/C—alrhandffng unifs <br />�'orced alr syslems <br />Gas I ►ng <br />Water heafer � <br />� Gas fife�lace <br />� Gas range <br />� Ciofhes dryer <br />Rangehood <br />Exhaustfan � <br />Heat pump <br />Unft heafer <br />Wo <br />5�'E2IRJFCLER / S�I��'��SS <br />Num6er of Heads <br />e of Pro]ect: �NBW _qddn _AlEeraflon �2epalr <br />Sho�✓Nunrber(#) oPtixtures <br />I Toifet <br />Lavatory (wash basin) <br />ShoWef ' <br />Ki(chen sfnk & dlsposaf <br />Dish�vasher <br />Gjothes washer <br />Water heater <br />Sinl< (service/%ar/mop/e <br />6ackflow p�eventer <br />Urfnal <br />Drinking �ountaln <br />Floor draln <br />Grease trap <br />Roof dralns <br />Medical Gas <br />Ott�er: <br />Ofher: <br />I hereby cariify (h�l I havo resd and exsmined Ihis apy(caGon ana know ��le es�pe lo ba truo and corrCct. Afi provlslong of lawg snd ordlna�cea governing fhfa typo of vlorkYlll Ce wmpUed <br />1VI�i1 Wnelher apacified hefCiO of Ool, TPIe grs�Ling o{ e pormil doeS �Ol pfes4ftla IogFva eulhodly !o v�olalo or cbncef Ipg pf0V161o0 Of sny ol�ef slsle o� I�eal ld�+ fegulefing canslYudiOn <br />ThSI I sm sulnorized bylheormc! o d roperly �o pe�form lho work forv�l(cp appilebi[on 1s medo end I wmplye,ilh lho Slale ConlraGor� l.sw 1B.2y �GW snd zea2oaA WAC. <br />l0_5_l � <br />owrior/A thorized(+ganEsl�nature Da�e (Revised3J2093) <br />