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Feb,ll. 2015 3;23PM EVERGREEN STATE HEAT & AC No,3518 P, 1 <br />' �PERMIT APPLICATr� <br />BUILDINC/IVIECHANICAL/PLUMBING/S1GN/SPRINKLER/DEMOL�TIOIV <br />C1'�Y OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-6890 FAX 425-257-8657 www.everettwa.org <br />ITE ADDR�88; <br />� I � � � PER7YTAXi1 <br />1-������rSL I I /V�I�C�- <br />AL for new conslrucllon: Short Piat/subdivfslon l,ol No. (allech wpy ollang I��al desCfipl�on) <br />�l� <br />�WN�R �Vll � � = Phone/E-mall <br />Address �Z� n ` Cily/S�ale2lp � �i �/� ,��2,'�� <br />APPLICANT:_Owner _OvrnersAgent �Canlractor _Conlraclor6Agenl „,,,,,,Tenanl(m�arPrav�deaie�iarormnsenirromv�ea,rnerwaowon�inweepace� <br />CONTRA�TOR � 5tale Lla #� � ?�OT Cil Bus. Lic. #� <br />Addrass 212Z� �/�C,��� L .� �V�, ��� Phone/Emal��� 7,S'Z— 3( � <br />i�NANT BUSINESS NAME CONTAGT FOFi pERIVIIT <br />�� S�� <br />BUYLbING �ERMIT APPLICATION <br />Phone/E-mai(�L� Z52 -31 ( �{- 425) ,�O�--p�?2Z. <br />CONTI�ACT PFZICE OF WO� �, DC� �`� <br />ExfsUng Use of �uilding � HEAT SOURC�; <br />Proposed Use of �uilding �as� Elecl�ic <br />Bullding type: _ Single Family _ Duplax �Townhouse ,,,_ Mulfi-Family _ Comtnercial <br />T'Ype of project: _ New _ Addition _ Remodel . Repair� T.I. _ Si$n _Sprinkler_Demolltlon_ChangE <br />DESCI�f PTION O� WORK (addrtiona! space provided on the beck) ; <br />C1n�-v�L Ou-`c G�t-s ���� <br />MECHANICA� �ERM�T �1l��LIGATIOI�1 <br />Typa of ProJact: _New�Addn _Alteratlon "Repalr <br />ShowNum6er(#) olllx(ures <br />A/C -- air handlin unfls <br />Forced air s slems <br />Gas pipin <br />Water heater <br />�as range <br />Clothes dryE <br />Ran9e hood <br />Heat pump <br />Unit healer <br />Boifer <br />Refrl�eratlon <br />� Other <br />KLERISUPPRESS <br />Number of Heads <br />of Use <br />PlUMBINC PERIVrI�' �1PPLICA710N <br />7ypeo�Project: _Naw_addn _Alteratl�n_Repalr <br />ShoW Number (#) of llxtures <br />Toilet <br />Balhtub <br />Lavaloiy (wash basin) <br />Shower <br />Kitchen sink R dlsposal <br />bishwasher <br />Clolhes washer <br />Sink <br />Urfnal <br />Drinking Founl�[n <br />Floor drain <br />Grease frap <br />Nledical C7as <br />Other: <br />Other: <br />i �ereny cartNy thal I have read end exemined Ihia epplicelion end know lhs seme (o be Irue and wrrccl. AD pYorrisions of laws and ordinanccs govorning lhis lypC oF work will be complied <br />H/t� �yhelne� speGfCee qerelq or noi. 7ne granqng o( a pefm(1 aoea nol preaume !o glve au�hority Io vlolate ar cencel tha provlslon of any olher blala a Iocel law ragulafing conswclion <br />Tha� I am aulhorizeA py Ine owner Is property lo pertorm ihe worK for wnicn apprfcsiion !s msae and i compy wPin me Siaie Convaciore Lew i8.�7 RCW end 296.200t, WnC. <br />� — `� l/" OC — <br />��� � <br />owner/Au�horized Agam Slgnature Dale (Revised 3/2013J <br />