Laserfiche WebLink
Jun- 15. 2016 3 : 40PM EVERGREEN STATE HEAT & AC No- 7279 P. 1 <br /> ERMIT APPL ICATIO <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_everefiwa.org <br /> SITE ADDRESS: . PROPERTY TAX It PEf?NIJT n '09 <br /> f If <br /> t.FGAL for new construction: Short PlaVsubdivisionL Lol No. (attach copy of long legal description) <br /> OWNER 13 (Zc3 l V✓l Pnone/E-rnall <br /> Address Cily/Slale%Zip <br /> APPLICANT: Owner —Owner'sAgenl YContraclor —ConlracloraAgenl Ton ant(mus+provide atatter oremseniframiheovmertodoworxinvia apses-)+ <br /> CONTRACTOR Slate LIC.# Cii Bus. Lic.# l5 J <br /> AddressI Z(-) LL:L <br /> Phone/Ercall g Z1 Z -- <br /> TENANT 13 SINESS NAME CONTACT FOR PERMIT <br /> s� <br /> Phone/F inall evt s L(/��D71it <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK a ;700, — <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of ullding Gas Electric Other <br /> Building type: Single Family _Duplex Townhouse _Mull-Family _Commercial <br /> Type of projecL New Addition Remodel. Repalr T.1._Sign_Sprinkler_[Demo]ilion Chane of Use <br /> DESCRIPTION OR WORK(additional space provide on he back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project; _New Addn `Alteration_Repair Type of Project: "New,^Addn _Alteration_Ropalr <br /> SlrowNumber(#)of fixtures Show Number(#)offiktures <br /> A/C--air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas flreplaca Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer f Clothes washer <br /> Range hood Water healer <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 /> Woodslove Grease tra <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other; <br /> Number of Heads Other: <br /> I hereby certiry Thal I have read and examined this application and know lho same to be(nre and correcl.All provwana or faws and ordinances governing[his type or work vdll be wmplicd <br /> with whothcr specified herein or not,The grsrrling of a permit doe&not presume to give aulhodly to violate or cancel the provision or any other stale or local law regulallng construction <br /> That I am authortzc by the owner or many to perform the wont for wn1cn application Is made snd I comply with the Slato Conlraclors Law 18.27 RCW and 29U00A WAC. <br /> OwnerlAu horize g nt Signa uro Dale (Revised 3/2013) <br />