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Ju1.29, 2015 7;58AM EVERGREEN STATE HEAT & AC N�.4842 �. 1 <br />�E�n�i-r ����.r��-r�o�' <br />BIJILD[NG/(VIEC�AMIC�►L/PLUIVI�rI�G/S1CIV/SPF�IN�CLER/�E11�i OLtTIOIV <br />�ITY OF EV�F�ETT P��IVIIT �ERVl�ES <br />3200 Cedar St., �verett, WA 98201 �25-257-8810 �AX 425�257-8857 www.everettwa.org <br />AbnR�SS: �l, <br />J <br />PROPERIY 7'AX t! <br />P,ERMIT# <br />� <br />f�EGAL for ne�v conslruclion: ShoR PlaUsu�dlvlslon Lot No. (altach copy of fon� le�al descdpllon) <br />OWN�R � � � I� Phorte/E-mall �Q6 1 � a•—g��jg <br />add�es5 � j 2 � r Clty/Sta(e21p I�v�(?��'i.T �, 203 <br />4PPLICANT; _ ONrner _ Owne�s Agen� � Contraclor _ Co�tracrors Agenf _-i enant (musiprovlaa e ieueroiconsenir�um me cns�,erio ao�vorfc fn �h�apa�e) <br />OfVTRACTOE� <br />ress 'L.l Z� <br />BtilyLb�NC PERM17 APPLrCA7[O[t� <br />� J� (�_ �State Lfc. #� <br />—3 f i� <br />Bua. �,Ic. # <br />�Fhaie/Em�ll <br />CONT"ACT �OM� p�1�1V117 <br />Ke�t 5aw C ��s� ?�'; 2 -3�iy <br />Phone/�-mali <br />CON7f�AC7 PRIC� OF WOR IIJ. /%F%(� � <br />Exislfng Usa of Building H�A'1' SOUF2CE: <br />Proposed Use of Building Gas� Elactrlc Olhar <br />Bullding type: �ingle Famfiy _ GJuplex _,_,,,Townhouse _ Multl-Farr�ify _ Commercial <br />1'ype of proJecl; w,,, NeW _ Addlllon Remac�el . Repafr_ T.I. � Slgn _Sprinfder _pemoli6on�„�Change of Use <br />DESCI�IF�TION OF WOF3K (addltlonal space proVlded oq �he bsckJ: �/ �j�-� �!l�1$5 �I��� <br />�n �N = r�-�f 6�s 1=�,�� � ��,� /�cti` ,� r� <br />V� d��� ��4 5( �"p i N� .�1 s�x:,-� b� D . <br />�1lO��E�d�INdC�4Q. ��RM1�' ��°�'tl.YIC�'►�'dOd�1 <br />ofproJect: ,�,,,Nev��Addii _Afferatlon___„Repair <br />Show�Jumher'(�) oPfixlures <br />A1C — air handling unl[s <br />� Forced air sys(ems <br />Gas plpinc� <br />Waier healer <br />Gas Pireplace <br />Gas range <br />Cl4ihes dryer <br />Ran�e hood <br />�xhaust fan <br />Heat pump <br />Unit heater <br />6oil�r <br />� Other <br />NiC��� / SUPP�ESSIOW SY5i�CVl <br />� Number of H�ads <br />��.a�nn���� ���me� ����.rc�aTror� <br />pe of ProJect: "New,_„_�1c]dn „_,_P,Iferatlon,�Repair <br />ShowNumber(�) oftlxfures <br />� Tollet <br />� Eaihtub <br />Shower ' <br />Kitchen sink �; disp <br />pfsh�vashar <br />Clofhes Gvasher <br />Water heafer <br />Slnk (servlce/bar/m <br />Backilaw preventer <br />Urinal <br />�rinkinfl �ountatn <br />Flaor draPn <br />Orease trap <br />Roof dr�lns <br />Mecilcal Gas <br />O fhor; <br />Other: <br />I htfeby cen�(y tha� I hsve raad end axaminad Ihts appfics��an snd know the eema [o bo fr�a and corrccl. �II pravisions o! laws anct ordinances governing Ihis Iype of work v6fl be cnmplied <br />wilh wtlelher spec1fled hereln o� noL 7ha granling vf � pefmil tioes po� p�esume fo glva aulhodfy lo violala or wncal Iho prov[slan oF ony olher slale or tocal fa�v regulal[ng conslrucllon <br />7hal I mm aulh0 ited py �he owne� oY s propedy �o podorm lhe VloYk fo� 1+�i�lc#1 sppllca�fon la rpade end I cornplyv�Rh fh� &iefa Conlreclora La�v 18.27 RCW end 296.200A WAC. <br />� , <br />� �����/.� <br />Own rlAufl7orizad Agent Sfgnature Date (Revlsed 3i1093) <br />