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Dee,31, 2(115 10:1�AM .�VERGREEN STATE HEAT & AC <br />N��, �974 ' P, 2 <br />� � r� � �� � <br />. ����� ��r��� � <br />��������i���������L���.,�a�����������r����������i������ � ��� <br />� C1TY OF �VEI�ETT PEF3flfll`�` S�F�VI��� <br />3200 Cedar St., �vereff; WA �8201 �25-257�881 Q�AX �25-257-8857 www.evereitw�.org <br />51TE � 1�D,. - �� n�-�' PC�OPER7Y'I"AXtt P r�r�i �� � <br />S� c % ` l ' <br />��GAL for new construetlon; Shorl P1HSlsubdivjsfon Lot No, {�ItBeh eopy of (�nD Ie�al descdptinn) - ' <br />OWN�R J!/ji./,Q� jCvv![yj Phone/�-mall - - <br />Address �! /JiL/qg � Clly/St�[elZlp ��"��� %✓�i `0 ��f <br />APF'LICANT: � Osvner ,� Owne�B Agerlt ,_, Contfactor � GoptfaClo��S AQe(1I � Teflaflt (mus� praylda a lelleYotwMenllfofll �he W+r}ef�o dp �vork ln lna epgce) <br />C7bh �1f�����(�� �� <br />``L122� �c-���C- AUE. �� <br />� �'N2l i�' �7�Ur.�ES <br />BC1�I�,bYNG PERNr�T APpI.1CA,TlOhY <br />!G(1'{� IStato L-lo. # ��%�t��D�'�� � City Sus. �,lo. $f <br />�,U.(� � ��D � Phonel�l�flll � Z� .- Z�2 � ( � �� <br />CONTACi qR P� M m`� �� <br />/�/?l�/G/� �Y� <br />B��-ma�� f��-252-3 <br />7FtACT PRICE OF WORK <br />�xisting EJse of suilding b��L� � �iEAT SOURC�: <br />Rroposed Use of �uilding �� C!-�l�jL.�i � aes�C , Electdc other <br />f3ullding iype; � Single �amlfy � Duplex Townhouse � Multi-t=9mily 1�' Commerc(al <br />Type of projact� _ New Addition Romodel � Repalr�T.l. �,_,_ Sign ,_,Sprinkler _DemolltlonJ�hange <br />P � <br />D�SCRIPTION OF'WO K(sddifional space proulded on the bacic): <br />r��:o�� � � � �,�5�,�6 �.� ��� �,� y��� � �����«�� �c� <br />L1��� 1 Ns�O� ' '�. �v��� r�e <br />iyy�eofProJect; _New_,J�ddn _AfteraklonTRepafr <br />ShoivNum6er(�f) ofiixtures <br />A/C, ah'i7andling units <br />Forced alr sysiems <br />Gas pi loy <br />Water heatQr <br />� Gas fifeplace <br />Gas r�nge <br />Cfothes d el' <br />Rsr�c e haod <br />� �xhaust fan <br />Heat pump <br />Unit he ter <br />J Boller <br />Refriger�flon <br />� Woocistove <br />puctincJ <br />_ � Oiher <br />W Sl9ISIT�!' �I.EF� / ��JP�������R� ,5�i�'1i. <br />Number of Heads <br />e <br />of Uso <br />,� <br />pe of Prajact; �Ne�v_Acidn TJ�IferaEion_J2epafr <br />Shaw Numbor (#} of fixlures <br />�atfitub <br />t�yafory (vrash basln <br />Sh�ower <br />Kltchen sli�k & dlspos <br />pishWashet ' <br />Clothes Washor <br />Water heatei' <br />Slnk (sorvice(bar/mop <br />H�ckflow preventer (lf <br />Drinkinc� �our, <br />�foor draln <br />Grease frsp <br />Ropf drains � <br />Medlcal Gas <br />Other; <br />Ofher� <br />I hc�cby ce�liJy if��l I h5ve reed end oxam�ned Ihls spppcallon end knoµ� �he eame lo bo lrua and cor�ecL Atl proNslong o�f���ys snd ordlnence9 g❑vorning Ihi3lypA of ��+ork ��11 �c complfad <br />vJ�i wheihcr sNe�Red herain o� not; Ti�e grsn�ing ofa pcRnfl doe, nal prasumo lo glrc ar�lho�ry �� v1o�y�e orc�ncel jhe provlelon oFeny olhaf slale orloaallavi tegiilall�tg con,Iruai;on <br />Thal I am �u �ed by iha 044�et ol lhl;, propariy to per�onn 1he vraric fvrvmicn appGc�rlon 1s rnada snd � comply vnU� ihe Sialo Con[ryc[ofs L��v 1a,27 RCW and 29 e,2ooA WAC, <br />/ <br />.,�r (�� � �)/ <br />awn ufhorrze ntSlgnaiur� Pa a �� (Rev/sed 4/20�6J <br />