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Sep, 14. 2016 234P EVERGREEN STATE HEAT &_ACAPPLICA71 No, 7863 P. 1 <br /> BUILD*/MECHANICAL ,LU',,ING r,IG#S,RINKL,RI DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-2618810 FAX 4255-257-8857 1(1-)everetteps@®vara(twa.gov I wvnv.avarettw✓a,gov/permits <br /> 'Wire I.F.®W*#0-i T <br /> PROJ!✓CT S1TF ApDRFSS: PROPFRTYTAX#: <br /> LEGAI-for new construction: Short Plat(subdivislon Lot Noy , (aftech copy of fang legal description) <br /> OWNER NAME- a TFNANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: 5-MEET Q <br /> Cf1Y STATE ZIP <br /> PWNI=R PHONR OWNED EMAIL, <br /> r <br /> CONTRACTOR NAME; Lr ( � t <br /> CONTRACTOR ADDRESS; STREET 2( L <br /> crry i SIXTE LAA, -JP <br /> CONTRACTOR PHONE: - - 3l/SL CONTRACTOR FMAI�: � vt <br /> CONTRACTOR LICENSE (REQUIRED): LUL c1TY01'>=VERETT130S1Nl;SS QGEu4SE#(R QL]1REb): 7 �! <br /> PRIMARY CONTACT: Q OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Zr�, - d 7 Z <br /> CONTACT EMAIL: <br /> -.¢ .BUII,DIi4g pl15RMit AR l:Yc1Ln6N <br /> Emsting Use of Buildin ; contract Price of Work:$ <br /> Proposed Use of Duifdin Heat Source: j6Gas C7Electric QOther <br /> Building Type; SI=R-Detached LISFR-Atfached ODuplex QMulti-Famiiy4 of Units: ❑Commercial ❑Industrial. <br /> Type of Project: QNew ❑Addition ❑Remodel MRepalr OT.f. QSLgn ❑Sprinkler QDemolition QChange of Use <br /> DESCRIPTION OF WORK: L�.4ovr�U D(.�i (_��Q G t` ,A&)A,�g U-kn� <br /> ASSOCIATED BUILDING PERMIT# if apElicable: <br /> 11111 CHA 1G�#� 1�RII>�1lTcAP)4?' �GAT�01'�l ' PLU . IN9 RERM1T�t4PPl:l i4T i_Oltl <br /> Type of project: _New Addn -_llteratfon �fispair Typo of project: _Now _Addn _Altarallon _Repair <br /> Fiitof UsfofFiXfures Fixtures List of Fixtures t"Ixtues List of Fixtures pfxfuf List ofFiVargs <br /> AJC--Air Handling Units Heat Pump 'Toilet Backflow Prevenfer(inside Bldg) <br /> ForcedAir Systems Unit Heater I Bathtub 10rinzif <br /> Gas Pfpin Boller Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Heater lRefrigeraflon IShower Floor Frain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal jGfeaseTrap <br /> Gas Range Micting IDJahwasher I Roof Drains <br /> Clothes Dryer Hookups Other: jClothesWasher Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Tufo etc. Other_ <br /> WOO. I IOf� <br /> Number of Heads <br /> ACKNOW1;F1 DaFMENP/have ravlewed this applicatlon and confirm the information confained herein is true and correct Worir done pursvent to this permit must cornp4l with <br /> current federal,state,and locallaw. The grsntinq ofe permit only aulhoriies approved work andno deviations therefrom.Deviations mustflrstbe euthonzed In v✓l ting from the <br /> Build/ng Ofltdal before being authorized under anyclfcumstance.tam the owner,orlam authorized by the owner of this pmperty to perform the work for which application Is made, <br /> snd l comply with the Stal Confmctor,Law 98,27 RCW end 296 200A WAC. <br /> City of Evamit Offidal Use Only <br /> I <br /> PER <br /> �--1 - I v <br /> OwnerlAuthorf d Agent Signature Pate (RBVIse 5/20/096) <br />