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10i1'7i2011 MON Iu: lO I'AS 42u J7A 7045 N'A NnCurnl Gn�; f�1002/OOJ <br /> i � <br /> PERMIT APF'LICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES /t7�/7�y <br /> 3200 Cadar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8B57-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM t AM TO�PM <br /> SITEADDRESS: PROPEFIiYTA7fN PERNIITN ,� <br /> LECiAI.for newwnslructlon: Short PlaVsubdivisbn Lot No._ (atlach copy of lo�q kpal deurlpfion) <br /> OWNER l'.wr 1 Phone/E�maB ' q ^ Q <br /> AECross GtylStete/ZJp� {X "\ �� <br /> CONTRACTOR L 8 1 Lic.p �S I�'� <br /> lWdrosa � PhonelEmaO ����I '�T( I� <br /> TENANT HUSINESS NAME CO TACT FOR PERMIT <br /> ���ll��Y� G-- �Cti"l-,8'�� <br /> Phone/Hnall _ a <br /> BUILDINIGPERMITAPPLICATI�"� CONTRACTPRICEOFWORK �l`U <br /> Exislinp Ue�:ot Buildinp HEAT SOURCE: <br /> Proposed Usaof Building Gas EkctAc IXher <br /> Building qpe: _Single Famity _Duplex_Townhouse _Mu10-Famlly _Commercial <br /> Type ot proJed: _New _Addilion __Ramodel _Repalr_T.I._Sign_Sprinkler_Damolitlon_Change of Uso <br /> ' Desul pUon of Work(eddi�lonal space povided on G+e backJ: '�. <br /> Have you slarted worklnp wllhout e permit? _YES _NO �� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIC ATION <br /> TypoofProJect: _New_Addn Alterallon_Rapalr TypaolProjacl: _Naw�ddn _Allaralla�_Repalr <br /> ShowNumWr N ofprfuras ShowNumWr A' olRxfuro <br /> AIC—airhandli unils Tollet <br /> Forced alr s stems Bathtub <br /> Gas I In Lavat wash basin <br /> Waler heater Shower , <br /> Gas firo ace Kltchen sink 8 dlsposal <br /> Gas ran o �iehwasher <br /> Ciolhes d or Golhes washer <br /> Ran e hood Water hoater <br /> Exhausllan Slnk servicelbadrtro elc. , <br /> Heat um BackOow evenler I <br /> Unil healer Urinal ' <br /> Boller Drinkin Founlain <br /> Refri era0on Floor draln <br /> Woodslove G�ease tra <br /> Ductin Roof drains <br /> Olher Meditai Gas <br /> SPRINKLER I $UPPRESSION SYSTEM other: <br /> Number of Hcads Other: ' <br /> I hereby cartify thal I have read end aramined this epplicalian and know Ihe aame Io be We and correc�.All provision�of laws�nd ordinenees poveml�p <br /> thb type ol v.ork vnll ba complied with Nfiolher cpeail�ad hernin or rat.The grentinp ot a pertnll doea not prosum�to give aulhotlty to vio�at�orcar�l � <br /> Ihe rovlslon of eny othar itale or local law rer,�latinp�onslr.icllan or the peAortnence of con5l�uctiun.That I em euthorlvC by Ihs o�+ner ol lhb DroGerty <br /> N e oi pe Nork for vMkh applitalion ic made end I compl with Ihe S ale Contncton Law 18.27 RCW and 296.200 WAC <br /> � 11� l �D� \'���� <br /> edA r ApmtSiynaturo ts (ReNsed7/20fi) � <br /> � � <br /> �� <br />