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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: - PROPERTY TAX N PERMIT# <br /> 813 Locust St Everett WA 98201 1 A,11 <br /> 01 - 0-92- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Everett Housing Authority Phone/E-mail 425-258-9222 <br /> Address 813 Locust St City/State/Zip Everett, WA 98201 <br /> APPLICANT:_Owner _Owner's Agent XContractor —Contractor's Agent —Tenant 1,n st provide a letter of consent from the owner to do work In tho space) <br /> CONTRACTOR Andgar Corporation L&I Lic.# 336, 680-00 COE Bus. Lic.# 24869 <br /> Address PO Boox 27008 Salashan Pkwy A102 Phone/Email 360-366-9900 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Dale Van Rooyen 360-366-9900 <br /> Phone/E-mail dalevr@andgar. com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building _ HEAT SOURCE: <br /> Proposed Use of Building Gas X Electric_ Other_ <br /> Building type: X Single Family _Duplex_Townhouse —Multi-Family —Commercial <br /> Type of project: New Addition Remodel _Repair_T.I._Sign_Sprinkler_Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Replace Gas Furnace - less than 100, 000 BTU <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New,_Addn _Alteration_Repair Type of Project: _New—Addn Alteration_Repair <br /> Show Number # of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> 1 Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) _ <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink service/bar/mop/etc. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> 01/19/2015 <br /> __w a Au ri2ea Agent Signature Date (Revised 6/2012) <br />