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May. 4. 2012 2:06FM EVERGREEN STATE HEA1 �, AC No. 1926 P. 1 <br /> � � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNlSPRINKLERlDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evered,WA 98201 -A25-257-8810—FAX 425-257-8857—w�we.everettwa.ory <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM S O ��Z <br /> SITEADDRESS: ^uQ� /� ,� � PROPERTYTAXM PERMIi�Y -�, 1 <br /> �` \� <br /> LEGALIornewconaWcllon: ShMPlaVavbCMsbn �a��•— �°11°�COpY°�10^���"'�PuO") <br /> OWtdER � PhmNE-moa - -J � I� <br /> Mdra�c 'p CIyI5laklZip IT"1 O <br /> �� <br /> GONTRAC70R Y L 8 I Lla p `a O <br /> Address�1� Y� O � Phone/EmaY a5-�5�. - 3 I <br /> TENANT9 9 CON 0 I <br /> � , PMnelE�rnall <br /> BUILDINO PERMIT APPLICATI�N coNrrv�CT PRICE OF WORK � 00' <br /> Exlsling Use of BUllding / HEAT SOURCE: <br /> Proposed Use Of BUllding �v'�' " Gas Eleclric Otha <br /> Bu�IdInD�YPg� _SlnpleFamlly _DUplex_1'ovmhousa _MuIIMFamily �Commerdal <br /> 7ypeotprojecl: ,�Naw �Addltlon _Remodel _Repetr1/T,1,_Slgn_Sprinkler_Demolitlon_Chenpe ofUse <br /> Descllplion of Work(addhbnal spue provkled on ihe back): <br /> n _ �,�, a �U°/e Q�p ��yA-•uC.c S t� <br /> Neve you sleAed worNinp wilh�It7 YES ,�NO U p� � I� ��S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PCRMIT APPLICATION <br /> iypeofPro)ect: ,__Jlew_Addn �Aibnllon_Hopair ryp�ofPropa: _N.w_Addn A11.r.0on_R�pdr <br /> SAowNum6er K o(firfures S�owNumber o�llxfuro! <br /> A/C-eirhendlin unRs Tdtet <br /> ForcedeUs lems BelhWb <br /> Gas iping Lavato wash basln <br /> Weter heeter hower <br /> Gas fircplace Kllchen slnk 6 dlc sel <br /> Gos range �iahwasher <br /> Clolhos d ar Gahe6 w6sher <br /> Renge hood Weler haater <br /> Exhaucl fan Slnk servlceber/ma elc. <br /> Heatpum Beckllpw reventer <br /> UNl healer ��e� <br /> Boiter Drl�kln Fnunlaln <br /> Refrl oraUat Floor drain <br /> Woodslove Gfeace Ua ' <br /> Duclin Roof dmina <br /> Olhet Medical Gas <br /> SPRINKLER/$UPPRESSION SYSTEM Olher: <br /> Number of Heads O�her: <br /> I hereby unlylhal i Aave read aM examined Ihk applwtlon and knowNe eama l0 6.i�u•and mrr.d.N�pmviebne ol4xe�nd or4inanoee govemine <br /> lhis lype d Hork vAll be complied Wth ufieNer epeGlted heretn or nol.The prentlng of a pertnit Eoe�not pruuma lo Owo aulror(ly lo vid.1.or e.nc.l <br /> iha provt.ton o�any olher a�eta or local lew regvlaling oonstmG�on a Ihe peAormance of consweilon.ThaU em authalxd by Ne ownarof ws propody <br /> lo ottn Na worK torrhic�applicatim te m�d�md I complywth Iha Slat�Conl�dna l.nw 18.27 RCW and 286200 WAC <br /> �v 1 ��1 a, <br /> OwnsAAvlhoriz•dAp�nlStpn ra DYb (ReNSed7/1011J <br />