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FROM :Evergreen State Heat 8 Aid FAX NO. :4252596660 - Oct. 11 2011 11:27AM P1 <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 91W01 - 425-257-8810 - FAX 425-251-8t157 - evww everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM A AM TO 4 PM <br />SITE ADDRESS: lL� " <br />yy J) <br />PROpLRTY TAx <br />Ma P1T 11 <br />I I o -� <br />LEGAL for construction. Srwn_ on_ _ _ Lot No. (attach copy of long legal description) <br />knew <br />_1Plal/subdnw <br />OWNER HL1-610300(] <br />Phono/E-mwl ` 1 0a5- DA6— 3a <br />Address-0 -Go u <br />City/State/Zip FJVL QA-chS <br />--- <br />CON7RACTOR OJ'I I IlU_ <br />LA I Lib. # 1F VQ7- Cl I <br />AdCI-=ssal2ru 'T Phone/Fnrall <br />TFNANI BUSINESS NAME <br />�. A <br />CONTACT FOR PERMIT <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICF OF WORK 00 - <br />Existing Use of Building f __ _ 11EAT SOURCE: <br />Proposed Use of Building G.1 ., on, Eleclrlc _ Other <br />Building type: _ Single Family _Duplex _Townhouse _ Mul -Family Commercial <br />Type of project: _ Now _ Addition _ Remodel _ Rapair 11. _ Sign _Sprinkler _Demotilion_Chango of Use <br />Description of Work (additional spaceprovided on the <br />aq°_P f' �vtuci� c) <br />Have you started working without a permit? .-_YES _NO�� <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Projncl; _New_Addn _Alteration_ Repair <br />Show Number(4 or Rxfdres <br />Typoof Prnh,cr. _.-New_Addn `Alloralion_Ropair <br />Show Number(#)oflf.furee <br />A/C -oir boosting units <br />_ _ <br />Toilet <br />B2thlub - <br />_ <br />Forced air systems <br />_ <br />Gas i In <br />Lavatory (wash basin) <br />Water heeler <br />_ <br />_ <br />Shower <br />Gas fir lace <br />Kilchon sink 8 disposal <br />Gas range <br />D,shwasher <br />_ <br />Clothes dryer <br />_ <br />Clothes hasher <br />Ron a hood <br />_ <br />W tiler heatur <br />Exhaust fan <br />Sink servlcdbar/mo /etc. <br />Heat pump <br />Backflow prevnnter <br />Unit hester <br />_ <br />Unnal <br />Boiler <br />Drinkinq Fountain <br />Refrigeration <br />_ _ <br />Floor drain <br />Woodslbve <br />Grosso trip <br />Duclin <br />Roof drains <br />Olhor _ <br />Medical Gas <br />SPRINKLER/ SUPPRESSION SYSTEM <br />r <br />Other. <br />Number of Heads <br />Other: <br />I hereby certify that i have read and examined this application and know the some to be true and wriest. All provisions of laws and ordinances governing <br />Ihle type or work wit be Coln plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the provision of any other state or local law regulating construe bon or the performance of construction. That I am authorized by the owner of this property <br />to perform the work for which application Is made and I comply with the Slate Contractors law 18.27 RCW and 206.200 WAC <br />Ow ethor4ad Age t 81gna ' slit (Revlead 2/2011) <br />