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Feb, 22. 2016 8 . 08AM EVERGREEN STATE HEAT & AC No, 6363 P. 1 <br /> ��C�fl�f �G�'f�L��C�QI.����' <br /> f��'���Vb��IGIl9��i���0�.���►�I�d..��1��h��1�0��11��G���[���6�1�����.Q��C��l <br /> C1��' A� �V����i ���IU11T���Vf��� <br /> 3200 Cedar St., �verett,WA 98201 �25�257-8810 FAX 42a-267-8857 www.evere�fwa.arg <br /> 511�A�DRESS: . PROPERTY�'A)C# P� �lli# <br /> (..�o , ��1 I ,Z- �� .� <br /> �,�GAG.for ne�v cons[rucllon; Sh❑ft PlaUsubdi�hslon� Lot No. (altaah�py of long le�a(rJescripiion) <br /> OWNER %� l l� FP�onel�-meil ' <br /> l0 c�cyis�s«i2ip � � _ C'1 � <br /> AdQress r <br /> APPl�fCANi�'...�.Owner _pWn�rsA�ent �Contracl�r �,Co�ltractoraAyent _,Te�anto-nuc[p�o�P�asieilarofwn-anirrorn�homvn�raQo��+��klnmaspare) <br /> GOiV�'RAC�'OR ��v �i �- 't�1 � � EQ4� � Stafe Llc.;k - ?Z-1 (}?Z�" Cfty Bus. LIC.#�- <br /> �? t�) 252—3 1 f� <br /> Address �.��� � ��(G.. hone/�ma11 <br /> T�NA ]�BUslf��s5 CVAn9E CONT'AC��O14 PEF;MIT � <br /> E!cc.� �-�r� C���J z�2���� <br /> phone/�mafl � <br /> �R�9L��II�I� ��Rf�d���'L�1�0��'P�Q�1 c��TR�C i Pt�fc�or WoRK 2,�C�. '� . <br /> Exlstfng Use of Buildinfl HEAT SOURCE: � <br /> 1��aposed Use oF�uildfng Gas � �fec(r�c_ Ol�er <br /> eul{ding typ�: �Single Family �Ouplex Townhous,e_Nful�i-Family _Commercfal <br /> Ty �oP roJect; ____New Addltlon _Ral'nodel -_Re afr �I'_I �Sign_5prinkler_Pemo]ltfon Change of Use <br /> p�SCRIPTION OF WORK(addit7onal spsce p�oN�ed oq the back); <br /> CIn��C�� C�c-��` �0�5. �'us2i_v�<-L% ��"( (�-�' �02 L.l I�.EJ <br /> su��c������� �����°�°������.����� �a.��vi�o�� ������'��������a�� <br /> 7�peoFPro�act: �Neti�J Addn �AffeYaYlon_Repair Fypeor'P�o]ec4� J„New�_�1ddn _Afteration_t2epair <br /> Sho�vNum�er(�)of�`Ixf�res ShoW Nr�mber(#)of fixfures <br /> A/C—alrhandlln unils �al�e� <br /> Forced airs siems eathfub <br /> Gas IE�lnq �aVafor/(wash bssln) <br /> Water iieater � ShoNrer ' <br /> Gas fitepfacs 1<itchen slnk�dis osal <br /> Gas r�nge Plshwasher <br /> Cfothes dryer Clothes washer <br /> RAnqe hood Water ileateP <br /> ExY�aust fan - Slnl<(servlce/har/mo /ete_) <br /> Heat ump �ackflow revenfer ' <br /> Unftheater Urinal � <br /> Boiler Drinklnq�ounialn <br /> RefriQeratfon Floor drain • <br /> Woodstove Grease{ran <br /> Duclln Roof dr�fns <br /> Other Medical Gas <br /> �L�L�9l�4F�G.��/ ���'�������1i9 ��"�u��� Ofher: <br /> Number of 1~leads � Other: <br /> I hareby cen�fy Ih91 I haVo read end axsminad(hIs spp➢wGon and knoW tP�e samp!o be true and�rracf.All pfov�elons of C�Ws and ordinanCes govarn(ng lA1s Iypa oFwork�1�11 be Campllcd <br /> W(�h wfiel�af spcciPlad hcYeln ofnot.Tnegrenfinyo(a pafmit tloea not p7esuma[a9NseulhoRtytDv�olelooYCs�cef lha proVfslo�o(sny olhef slsle orlocal l�lvfegu�efing cone[n.idtOn <br /> T�rsl�am sulharized Qy{hc O��snFr of Ifil�proporly[u paii'orm Ine wark iorv�hl�h Qpp1[cstlon Is maae snd 1 compfy vllh tho Slale Con�reclors LA1`I 7 a,2'�RCW&ntl 298,200A WAC. <br /> 2-Z2-t� <br /> ����V✓ � <br /> Ov✓ner/A«thorized Agen gnafare Dale (Revlsed 3l20i9J <br />