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Nuv.2�, 201� 12;�7PM EVERGREEN STATE HEAT � AC No,�726 P. 1 <br />����������u���n�� <br />���������n����a�s�c�������n�i��r����»��o��������►�o�i�r�o� <br />C�I°l`Y ��= EV�I��i� PERI�Ii ��RV[��5 <br />3200 Cedar St., �ver�tt, WA 982�1 425-267-8810 fiAX 425-257-Ss57 www.everettwa_ory <br />SITE ADPRE55: PROPERTY iAX ti <br />2� l I -.— �l4—t�-� �Q. 4t�. - <br />[�EGAL for new constn�cilon: ShoR Alaf/eubdiJslon Lot No. ,(elPach copY of lonfl fegal deecripfio�) <br />OWN�R ��iiiQl� V DG� � -- Phane/E-ma[I �"i� .��fJ -- -- <br />� <br />i�ess 2O� 1 ---- � �=-E �(.� ��tZ- �Clty/Slale/Z(p C� �� l.ea°ti� �4S2b3 — <br />P�ICANT:�armor _ownar'sAgent �--Gonlractor �,Co�tracto�sAganl ____"�enant�rnusirrovloeal�if�rof�n��nirromU�am,�„er�odo�roh,inmaepac�) <br />cofVTRacTOR <br />l <br />BU1L�I�IC PL��t[ifll� AP��IC�b,Tll�� <br />� f� � . �Sfato Lic, <br />—31i�s <br />�Ll3. �TC. � <br />�I�flone/Emafl <br />COtdiACT �oR P�I�IVII`P <br />K�c� �� C ��s� 2�� ���� <br />Phone/�mail d vl(�� �ZZ '3 <br />coNrRAc�� �Ft[c� oF woRK % raf'�'i. <br />Exisffng Use oP Bulfding , � <br />1�roposod Use of �uildin�7 <br />Buildinq type: � Slnyfe Famlly _ �uplex �Townho�se "„ Mul�i-Famlfy _ Commerclaf <br />Type of project� New Addlt[on Remadal .� Re�air,�, T.l. _ Slgn _Sprinkler <br />�� <br />p�SCI�IPT(ON O� WOR�'C (aridltlonslspaceprovldedon �heb�ck): , <br />c�k�d c.: oc,�.-� L.P �u. r�►�� <br />� <br />DVf�CbA�'.'���►Q. P{��d[VIC'!E' �#���IG.4'�'9�� <br />l�rpe oF ProJect: _Nev�w.�qddn _Aiteration �eE�air <br />. � <br />ShotvNumheY(#) ofllxfures <br />A/C � air handling uniis <br />Forc�� air s s�ems <br />Gas pfpfng <br />Water heatar � <br />� Gas flreplac� <br />Gas �ange <br />Cfothes ciryer <br />Ranqe hooci <br />�xhaust fsri • <br />Heat um <br />� Unit heater <br />� a�llef <br />�� � Refrigeratlon <br />Woodstove <br />� Other <br />��Ri�t��.�� / su�l���s�rra� ��'���� <br />Number of Heads <br />11EAT SOURCE: <br />�leclrla 0 <br />Channe of Use <br />!l���1VI�d�ia P��1VIY� A�P�.dCA�'!O�`d <br />� of ProJect: ,�New_Addn �/1lieraiion �Re�afr <br />Sf�otYNam6er�#) offlxfures <br />� Tailef <br />� Haihtub <br />� Lavatory (�vash basln) <br />Showor � <br />Klichen slnk � dis o�a1 <br />Dfshwasher <br />Clothes wash�r <br />UV�ter heafe� <br />Sink se�vlce/b�r/mop/etc. <br />eackFiow �reventer <br />Urinal <br />Drinking FounPaln <br />Flaor drairti <br />Grease frap <br />}2oof cirafns <br />Niedfcal Gas <br />I Qfher: <br />Oiher: <br />� ��eraby ceftify lhsi f hbvo rtad snd exarrinad Ihis app1lca�o� end knoa� 9ile same io bo Guo �04 cOr�ec�, AO p�ovisfons of IawS spd ol�llne��cea govaroin� lhis lype o f�^rork v�ill bc Golnpllad <br />Wiih 1�'�o(hcr SpeGpad herofn ornoL T11e grenlfng oFa paf�nU doee nol presume �oglvo eulho6ly fo Yolata orcancef iho pfoVsion of an/ o��ers�sla ar local lav� reyulsirng conelrucllon <br />lTsl I srn aulhorl�ed by Iha ovmcr 0 erly lo pcRoffn I��e wurk for vrhicll applfcelfon 1s made �nU I mn�pry �vlth tho S[alc Ctinl�ciol= LaW 16,2'] RCW and 29C,.200A WAC, <br />�.-� 1 / - --/ 5' . <br />Owner/AUthorfzed Agent Sl�nature Da[e (Revlsed 3l2013) <br />