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Jun, 3, 2015 1:35PM EVERGREEN STATE HEAT & AC No.4465 P, 1 <br />�ERMIT APPL�CAT�O� <br />BUILD�NG/IVIECWA�NlCAL/PLUMBING/S1GN/SPRINKLER/D�IVIOL1710N <br />CITY OF EV�R�TT P�RMIT SEIZVICES <br />3200 Cedar St., �verett, WA 98?01 425-257-8810 FAX 425-257-8857 www.everettwa_org <br />� � ��12-- ��I r,��7 t't /l <br />ITE /�1D1]R�SS: <br />� �t� _ _� �[: <br />oPERrr rAx � <br />� <br />LEC3AL for ner� conslrucllon: 5hort PlaUsubdi�ision Lol No. (allach copy of long legal descrlpUon) <br />pWt1ER JG-�C�(___ ILC�'2+QL- i� r i'hone/E-mal ��� 2.�j �5�� <br />Addresa v`z��� �L� � �/���}�' Cily/S(a[e2ip &/ ��/ <br />APALfCANT:�„Owner _OwnersAgen� �Contractor _,ConlractorsAgeM �Tenenl(m�s�P�o�idealeilerai�n.rrnfrom�hao„�n�rmdnworxinNeepace) <br />r` �7 , i . A w .--- _ M � __ .� <br />ONTF2ACTOR (��C�(�� <br />idress �� � b �i4� <br />G <br />���� !/�.��.�a�-- <br />BUrLDIT�G pERIVIIT APPLlCAT10N <br />Stale Llc. # <br />� CIfY BUS. �jC. <br />IPhone/Emall <br />cvN7Ac7 FOR p��nn�r ,,�/, ^ <br />7 �i/���s5l��l l.(�0.,.L� �'1'1 <br />Phone/�-meil �C� �L� ( �-z�) 25Z� 3�"r � <br />coNraacr pRic� o� woux /3, Q� <br />ExlsUng Use oF suilding � <br />Proposed Use of Building <br />Building iype; _ Single Family � �uplax.w,7ownhouse _ Mu111-Famlly�Commercial <br />Type of proJecl: _ New Addltion emodel . Repalr _ T,I, _ Slgn _Sprinkler <br />_ � <br />D�SCRIpTION O� WORK (additional space provlded an l�e Dack) ; <br />�(91,�1 f=Y C� i�i ST'C �'C,� ��C.�-c^j, Ft7.t� G�L6��7'� ����, <br />ME�i-�A�1frC4L E°�RMIi AP!°LlCAT10N <br />Type oF ProJact: _New�Addn ._�Iteration _,,,Repair <br />ShowNumbar(#) o�1/xlures <br />A/C -- air handling units <br />Forced air s stems <br />Gas pipin <br />Waler heater � <br />� Gas flreplace <br />� Gas range <br />j Clolhes dryer <br />Range hood <br />� Exhaust fai� • <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodsfove <br />Ducling <br />Ofher <br />R / SUpPR�5SION <br />Num6er of Heads <br />NEAT SOURC�: <br />of Use <br />PLUM�ING P�RlV1�T �1PPLIC/�TION <br />pa of proJact; _New_}lddn �Alleratlon ___,Repalr <br />Show Number (t�) of f/xtures <br />I 1`oilet <br />Lavatory (wash b <br />51�o�v�r <br />Kilchen sink & dit <br />Dishwasher <br />Clnlhes washer <br />Wafer heater <br />Sink (setvlce/bar/ <br />Backflow prevenli <br />Urinal <br />C�rinking Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />Medical Gas <br />Olhar: <br />O fher: <br />1 hereby ceriify lhal I Rave fe9tl an4 exsmined lRls sppQcytlon a�d know Iha eeme fo be [rue end corracl. All pro�isions of laws end ordinancas govarning lhis lype of wolkt�lill be Compfied <br />wilh whalhar speci�ad heYefn or nol. The AYenling of a pefrilil qoee no► pfesume la glve eulF�odry lo vlotele or cencel lhe proviaian o( eny olhar steCe or locel lew regulalfng conswclion <br />7ha1 I em aulhorized by lha mvnar of 1� aAy to peAofm Iho work fofwiifcll app�)csllan ls m8tle ana I�mpiy WAh Ihe Slaia �on�raciora Lsw ta.27 FyCW and 2ea.z6oA WAC. <br />� • <br />�3_lS` � <br />Owner/Authorized Agent Signature Dale <br />(Revised 3/2093J <br />