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From: / 03/2(F/2012 11 :32 N045 P.002I003 i <br /> � 582zd--�- <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNlSPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evc-ett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM "aZ� �I2 <br /> SITE ADDRESL: � PROPERiY T/U(N PERMIT N <br /> �UO W� - 5 <br /> LEGAL�or nnw�onstrucUon: Snon P�aVeubdivision Lol No._ (ailec�copy ol lonp leOal Oefcnption) <br /> OWNER 'r] L� PhondE-mail Cj•- J '"� o'�- <br /> Atltlress ���� �1.��(- � Ci;ISlate�ZlP GvE.1 e� W "1�2�j <br /> COHTRACTOR 1'V Q l 8 1 Lic.# I I C • W O C <br /> Adtlross '�yD 132 A�1e � �� Q.1� W 7'l �honelEmail ,7 <br /> TENANT BUSINES NAME C�ONTACTnFOR RMIT 2s �03�0•7 <br /> J a�1G l.as �,� I- �- <br /> AhonWE•mail �� 0.�n �Q � G�� <br /> BUILDINGPERMITAPPI.ICATION CONTRACTPRICEOFWORK �O.`— <br /> F�cisling Use of Building e P�C� NEAT SOURCE: <br /> Proposed Use ol Building Gas Hectric OUor <br /> Building type: �Slnple Femiy _Duplex_Townhouse _Mult{-Family _Commerclal <br /> Typo of proJact: _New _AddHion _Remodel�Repair_T.I._SIBn_Sp�inkler_Demoittion_Chenge ot Usu <br /> Descriplion of Woi1c(addMbnel spece provided on fho beckJ: <br /> �e-rnou�� �\ace �as w�c� ���• <br /> Have you slatied working wtlhout a permit7 `YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of ProJo�t: _N�w_Atldn _Albrallon Repalr Type of ProJeal: _N�w_Addn _A�iontlon_Hop�ir <br /> SAow Numb�r(M)of Hrfuns Show Numba�(MJ ol flaYurcs <br /> � A/C-airhandlln units I Toilet <br /> Forced air s slema Bathtub <br /> Gas I In Levalo wash basin <br /> Water heater Shower <br /> Ges flreplaca Kilchen sink 8 dis sel <br /> Gas ran e Dishwasher <br /> Clolhas d er Clothes washer <br /> Ren a hood Water heater <br /> F�hausl fan Sink servicel6arlmo alc. <br /> Heat um Backllow reventer <br /> Unit heater Urinel <br /> Boilar Drinkin Fountain <br /> Refr aratlon Floordrain <br /> Woodstove Grease Irep <br /> DUUin ! Roof drains <br /> Other ! Modical Gs6 <br /> SPRINKLER/SUPPRESSIOP! SYSTEM Othor: <br /> � NumberofNeads ` Othor: <br /> 1 heroEy certfly llial I hava read an0 ezemined thla eppllcalion anA knawlhe seme lo De true and correcl.All provlsbn�ol lews and ortlina�xea governlny <br /> ihis lype ol�wrk vd�l bo complicd with v.ficlher epocif ad hemin or no4 Thc pranlinD ot a permlt doea not preaumo la pNe autnaity�o violate or�ancel <br /> the provialon ol any olha�state or bcal lawre0ulatlnp constfuction or lhe peAorma'xe ol wnatruqion.That I am aut�ofizod by Ine rnmar ol lhb pmpehy <br /> lo peIrtort/n Ihe/wark lorwhleh applicalion Is matla und I compiywilh the Stale Conlndors Lew 18.27 RCW antl 296.200 WAC <br /> h,N/l� ( G:Y� ��Z(n � I 2 <br /> n�rlAut�odz�tl Apml pn�tura �T Dale (Revised?/20HJ <br />