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FROM :Evergrcen State Heat 8 AiC� FAX N0. :4252596660 � �ct. il 2011 09:24RM Plil <br /> � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CI'fY OF EVERETT PERMIT 3ERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-267-8867-www.evctettw .org <br /> APPLICATIONB ARE ACCEP7ED FROM 8 AM TO 4 PM // � I� <br /> SITE ADD ESS: OPEN7Y TAIf M PER IT t <br /> LE6AL�o�naw mncVuct�on� Shon PicVcuoo�wc�on_ Lot No_ (atnen wpy of lonp lepul eucqpUon) <br /> OWNER PnondE•m�tl <br /> ndero.. � Cny/51elUZlp q <br /> ONTRACTOR L 8 I Lic.# a b <br /> Atltln�c (/�+ VMnUEmall � ;J ( <br /> . � <br /> Phona/E-meil <br /> sU1LDIN0 PlRMIT APPLICATION oNrr�cT PRICE oF wORK -' <br /> Exisling Use of Buildlnp T SOURCE: <br /> Propoeed U!e M guIldlOp �-�r_____. Gea Elecinc Other <br /> Building Ippe: ✓ Slnple Femlly _Duplex_Townhou6e _Mulll-Family _Com�rwrclal <br /> Type oi Drolx� New _Addil�on _�Romodel .,Repeir�T.L_Slpn_Sprinkler_Demdltlon_Chanpe o1 Use <br /> Descrlptlon of Wak(edArtanei enncx o«+vnix�i on na nx�:w� <br /> Haw you�taAed working without a permit7 _YE9 _NO <br /> MECMANICAL PERMIT APPLICI►TION PLUM�INO PERMIT APPLICATION <br /> 7ypeulProJ�C�' _New_Addn _All�f�llon__R�p�if Typ•o1VruJeot; _New_Addn _Altentlon_R�p�lr <br /> ShoWNumWr olll+funOl 8f10WNUTDN ane�ro, <br /> A/C-Blf hPndlln Unlls lel <br /> as�Foreod alr s slems Bethlu6 <br /> � Lavat weah basin <br /> Wa�er heeler sfawa <br /> as n aca hchen sink 6 dia mal <br /> Gae ran Gahwaeher <br /> Go�hes A er o�hea waeher <br /> Ran a hnod Welar heater <br /> Exhaust tan ink servicePoedma /etc. <br /> Fleal um ack Iow reV¢nt@r <br /> Uni�heatar rinnl <br /> Bolle/ Drinkin FouMain <br /> Refn eralian Flar drein <br /> Woodsleve areaw trap <br /> Ductin o�. tlraln�e— <br /> Other Medlw;Oes <br /> SPRINKLER / SUPPRESSION SYSTEM O�her <br /> Numba oiHoads Other <br /> I hmeby canlfy t�at I nave reed antl eremmW ihie epp�icelian srb krrow Iha eeme ta be trw antl een�cL All provhlont ol Ixw�nnd ordlnnnro�qov�min0 <br /> Inis lype ol work vnll ne GomD��ea wlt�wheihar epeC10eel hereln or not.7ne pranlinp ol�p�rm�do�e not Dro7ume lo pM�1�horlty lo vialal•or c�ncel <br /> tha Diovlelon ol eny other slnte or bcal lew r�g�l�tl�+g con�iruction or the pedormanes ol ConUrucUo�.Thet I am aulhonntl hy Ihe owner ot thi�proDMy <br /> In adarm 1'�e Hotlt lv�whwh e0P6uhon 1�m�tl�end I mmD�y w�lh ihE SU�E COntriUorc 4w 18,17 RCW MO 2B9.�00 WAG <br /> 1 � � � " � � —� <br /> Ownu uUa1:MApon1 Ip ro Dau (Ro�iaoAY2017J <br />