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Nov. 21. 2016 10 57A EVERGREEN STATE HEAT & AGAppLICA`CIObf ' No. 8373 P. 1 <br /> SU'ILD11— MECHANICAL I PLUMBING 1 SIOMF=RINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98209 <br /> (P)425-2155-1-8610 J FAX 425-257-8857 1(E)everetteps@evereti%va.gov I wmy.everettwa.gov/permi(s <br /> rIl$Iag 111k Os0.p!%�)(e�se)CT SITE ADDRESS: . a3 2 PROPERTYTAX-ff: <br /> for Haul construc[lon; Short P]aVsubdlvislon �y �. �y Lof yN�po./q ny(a[fach gopy of Long legal ileac ription) <br /> i idly rkd 1 11 9'® �Y1F'°���■�7 - - _ .. - 't <br /> OWNER NAME; TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�T�aar g5�3 G <br /> CITY GiSTATE �� - 21p <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; L f <br /> CONTRACTOR ADDRESS: sTREET I CL � 7 <br /> COY STATE zia Rc5 <br /> CONTRACTOR PHONE: / CONTRACTOR EMAIL: <br /> GONTRACTOR LICENSE CITY dP EV1:lll±TT BUSINESS LICENSE#(REQUIRED: <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR Ll OTHER(Please Specify) <br /> GON1'ACT NAME: CONTACT RHONE: (qZf) 5C>6— C17 Z-2- <br /> CONTACT EMAIL: Ssm tea, 1 <br /> BUI D1rYGTdER1VllI'I",AIR PUPPT10. <br /> F)dstinq Use of Building: Contract price of Work:$ <br /> Proposed Use of Building: Heaf Source: as LIEleetde DOther <br /> Building Ty e: FR-Detached LISFR-Attached EiDuplex Omulti-1-ami1 -#of Units: LiCornmerolal ElIndustrial <br /> Type orProject. ❑New DAddition ORemodel Repalr DT.I. 11S1gn OSprinkfar L1Demolitton IJChange of Use <br /> DESCRIPTION or WORK: <br /> C A5 1Zr�l Aad <br /> ASSOCIATED BUILDING PERMIT#(if ap licable <br /> tin c><�t� rca l 1t" rt' f�oKc rf®ry = Pu PING"eeRrof-_,�O)LICATION <br /> Type of Project: „„New_ Addn _,Alteratlon _RepaPr Type of Project: _New _--14ddn Iteration _Repair <br /> #of Llst of F&tures WFIxtures <br /> fFixfures #of tfSt ofFlxfures #of List of Fixtures <br /> F1Xftrres Fixtures FixfuresA/C—Air Handling Unitsmp Toilet 13aWow Preventer(Inside Sid )Forced Air Systemsater Bathfob Urinal <br /> Gas Pi ing Lavaca Wash Basin Drinking FountainWater Heateration Shower FloorDrainGas Fire lacetove Kitchen sink&Dfs osal GreaseT'raGas Ran a I Dishwasher Roof Drains <br /> Clothes Dryer Hookup other. jolothesWasher Medical Gas <br /> Range Haod Water Heater Other: <br /> Exhaust Fan Sink(Service/13ar/Mop/etc.) lother, <br /> _.,��5 )CTdRIl1�D,ly� ;�I.�1P��tl?=`�S)( •�1Cs 1.1~.1Sn - <br /> Numberof Heads <br /> ACKNOWLEOGEMFNT_I have mvlawed this application end conllmr the lnformatlon oontsinad herein Is true and oormcf Work done pursuant to fh2qpermit must comply wish <br /> currentfederal,state,andlocal taw.The granting ol'a permlt only actthodzas approved wodcand no devlalions thsrerrom.Devlallons mustflrstbe authorized in willing from the <br /> Sanding offictal before being authorized under any o1mumstance-I am fhe owner,orl am authorked by the ov✓ner of this property to perform the worn for which application iz mado, <br /> and I compel v✓ith the S ate Contractors[a 7 RCW and 296.20A WAC <br /> MY ofEVeretf Offlcl`al Ursee only <br /> Owner/Authorized Agent Signafure Date (Revised WO,1201 ti) <br />