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Jul, 29. 2016 1 . 33PM EVERGREEN STATE HEAT & AC-APPLICATIr No. 7565 P. 1 <br /> BUILD J MECHANICAL I PLUMBING I SIG !7 PRINKLER I DEIIl1OLITION <br /> CITY or EVERETT PERMIT SERA <br /> 3200 CEDAR STREET,FVERETT,WA 98201 <br /> (P)425-257-8810 FAX425-257-8857 J(F-)evsreI1eps@avaTa(l:wa.govJ wvnlv.averellwa.gov/permits <br /> � 1 it "C){C ok-pow P�®ase) >h�@ �2�T Ce.91TE 1P 0 [9lJATI® Y <br /> PROJECT SITE.ADDRESS: C PROPERTY TAX V: <br /> I-EQAL for new construction: Short PlaVsubd(vlsfon Lot No.- � (altach copy of long lega(descriptlon) <br /> �Nt dim <br /> OWNER NAME: — TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREE-r <br /> MY l.i STATE ziP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACYORADDRES S., 6TREE7 /,I ZO C( cc O �^ <br /> 01IY -� STATE , 71P G'9 LTJ <br /> CONTRACTOR PHONY:NJ ZS-2_— CONTRACTOR EMAIL: Ke ee>o-t <br /> CONTRACTOR LICENSE V(REQUIRED) S CITY OF EVERETT 13LISINESS LICENSE#(RVQUIRED): <br /> PRIMARY CONTACT: I=]OWNED CONTRACTOR LI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:C J 5 g 2-2-- <br /> ?A <br /> k CONTACT EMAIL: <br /> a� <br /> PFRMIT;APE! fr*t[6 <br /> Existing Use of Bullding: Contract Price of Work:$ f <br /> Proposed Use of B Ilding: Heat Source: Gas lkloctrlc MOfher <br /> Building e: FR-Detaohed QSFR-Attached []Duplex EIMulll-Famlly-#of Units: F]Commorcial [Alndusfrlal, <br /> Type of Project: El New L]Addltlon ORsmodel DRe air LIT.I. L1SIcgn L1Sprinkler ODemolition E]Change of Use <br /> DESCRIPTION 01=WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> NI GHA CAL: pLy.DIN[BI111C E?L�N1lT;AP)�L��A��ON <br /> Type of Project: ___New Addn _Alteration ___Repair Type of project. _New Addn _Alteratlon „,,,,Repair <br /> fur K isf of Fixtures 1lxfuros Llst ofFlxtures ! of <br /> List of Fixtures F�kfo <br /> 8rros List f f i�rturms <br /> WC—Air Handling Units Heat Pump Toilet I BacktlowPrevenfer(lnsider3ld <br /> orced Alr Systems Unif Heater Bathtub Itidnal <br /> Gas Piping I Boiler Lavatory(Wash Basin) prinking Fountain <br /> Water Healer Rafrigeratfon Shower Floor Drain <br /> Gas Fireplace JWood Stove Kitchen Sink&Disposal Grease Trap <br /> 2Exhausf <br /> Ducting Dishwasher Roof Drains <br /> er Hookup Other: Ciofhes Washer Medica!Gas <br /> Water Heater Ofher: <br /> Sink(Service/Par/Mopleto,) Other. <br /> a <br /> SPR>ILI »iri >, sit®�a[_ vs�rEi; <br /> Number of Heads <br /> ACKNOWLEOGEM,90'1 have reviewed this eppGcelion and confirm the Information contained herein is true and correct. Work done puraoant to this Perini[must comply with <br /> current I®dere/,stafe,and Iocel taw,The gmnling of*permit only authorizes approved work end no deviations therefrom-Devdatlons mustflrst be aulhortced in wrihng from the <br /> 13uild/ng Oh9ctal before being authorized under any arcumstanca f am the owner,orl am authorxedby the ovrnerof this property fo perform the work for Which eppllcallon Is made, <br /> and 1:empty with the State Contractors Lave 16.27 RCW and 296.200A WAG <br /> City of Evwutf Off!al Use Only <br /> PER IT# — <br /> Owner/Author;zedAgen[ re Dale (RevisedWW016) <br />