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Dec. 2. 2016 9 . 59AM EV,E�aREEN STATE HEAT & AC-APPLIC,gTINo. 8433 P. <br /> BUILDI i MECHANICAL i PLUMBING i SIGNS PR�NKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRI=ET,EVERETT,VVA 98201 <br /> (P)425-257-8810 1 FAX 425 257-8857 I(E)evereiteps@everettvta.gov I wwmevere(Nva.gov/permits <br /> PROJECT SITE ADDRESS: 7q ,0 k, J4+ PROP1rRTY <br /> LEGAL.for newconslructlon: Shoat Plat/subdlvislon Lot No. (attach gopy of long legal description) <br /> OWNER NAME: ) T8kIANT NAME(if Clommercial): <br /> OWNER MAILING ADDRESS: aTRPEr �i�/ <br /> crit C.�VL+r��:: STATE (�( 2[P % O 3 <br /> OWNER PHONE OWNER EMAiL: <br /> CONTRACTOR NA045; '241 2 <br /> CONTRACTOR ADDRESS: aTREEr /N <br /> on �Je STATE UA- Z[P �7g zo <br /> CONTRACTOR PHONd ?-- Z 3(/t(- CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(RF-QUIRED); CI fY OF EVERETT BUSINESS LICENSIi#(RFgUIREo): <br /> PRIMARY CONTACT:^Q OWNER CONTRACTOR EI OTHER(Please Specify) <br /> CONTACT NAME: � CONTACT PHONE: <br /> (-Z CONTACT EMAiL: <br /> Existfng Use of 13ullding: Confract Price of <br /> Work:� <br /> Proposed Use of Building: HeatSoorce. �E1Gas QEle0i'do QOther <br /> 6ullding Type: EiSFR-Detached ❑SFR Attached EiDuplax ElMulti-Farnil -#of Units= ommerclal Cllndustrial <br /> Type of Projecf: EINew OAdditfon ❑Remodel palr EIT.I. ElSfgn ElSprinkler UDemolitlon ❑Change of Use <br /> DESCRIPTION OF WORK: , <br /> ASsOCIATRI)130ILDING PERMIT#(if applicable), <br /> . ._ _ . . .j0M---I0*ri )Ei ISI ztvlT<rd pier MF Type of project: ,,,,,New_ Addn Alteration _._-Repair Type of Project: ,_•Ne%v Addn Alteration°fLlstof rIxtures #or Lfst ofMfures #°rLlsf ofFi5dures #°rList oF•iXturea ir/xfures Fixtures PikWresIVC—Air Handlinq Units HeatPump Toilet Backf wPreve <br /> P��Forced Air•Systems Un It Heater Bathfub Urinal <br /> Gas piping Boiler LavatoryWash Basin Drinking Fountain <br /> WafeMa <br /> rlgeratlon Shower Floor Drain <br /> Gas Fd Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Rting Dishwasher Roof Drains <br /> Clotheer. Clothes Washer Medical Gas <br /> RangeWater H®afar Other: <br /> ExhauSink(ServicefflarlMop/eto. IOther; <br /> Number of Heads <br /> ACKNOWLEOGEM1=NT-I hn ve revlawed th/s applicetian end eonflrm the lnformation contained herein is tnre end correct Work done purseant to this permit must comply with <br /> current federal,sfate,and locallaw. The granting of permit only authorizes approved work and no devfatlons thererrom.Devfaflons musthrstbe aulhorrced in writing from the <br /> Building Of,Scial before being eulhorhed under any circumstance-l am the ownel,orl am authorized by the owner of thls property to perfom,Me warkror which application is made, <br /> and I comps with the State Contractors I aw 98-27 RCW and 298,200A WAC. <br /> City of EverettOfRclal use only <br /> PE Ire <br /> OwnerfAuthorized Agent Signaf tire Date (Revised 5/2CIP1o9E) <br />