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01/20/2012 FRI 13:10 FAY 425 379 7045 WA Natural Gns �oo2/OOJ <br /> ( l <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8610—FAX 425-257-8857—www.evereHwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM — o`I 3���' <br /> srce(052 ss: �- PROPERTYTAXR P ««7�/- <br /> , <br /> LEGALfornewconsWdlon: PlaVsubdivlsion LotNo._ S+�"���PYab^7M9aldecuiplion) <br /> OWNER S Phone/E•mpll 25 -5i - R � <br /> Addresa qlyl5Ule2iP <br /> CONTRACTOR �����t�# N �`� <br /> Addrass � PhonelEmaO Z� <br /> � TENANT BUSINESS NAME CONTACT FOR PERMIT � <br /> PhonelE-mail <br /> BUILDIN(iPERMITAPPLICATION CONTrtACTPRIceoFWORK ' O. 92 <br /> ExisOng Use of Buliding HEAT SOURCE: , <br /> Proposed Use.o/f'�Buildtnp,� Q �Q��Q Q Ga Elsotrie Other <br /> Buldinglype:�5(ngleFamily _Dup�ex Townhouse _Muld-Famliy _Commerdal <br /> Type of proJeu _New _AddiUon _Remalel _Rapalr_7.I.�Sfgn Sprinkler_Demolition Chanpe of Use <br /> DeScripUon of WOtk(addiflonal apace provided on fhe back): <br /> '�����G�t OIC� �1.�✓1�1L�C-� <br /> `) <br /> Hava you startod workln9 without a parmit9 YES _NO ' <br /> MECNANICAL PERMIT APPLICATION PLUMBtNQ� PERMIT APPLICATION <br /> . Typ�otProJ�el: _N�w_Addn �Itaration_Repair TypeofProJeot: _N�w_Addn _AlUratlon_Rp�ir <br /> ShowNumbu K o/Nxtvrcs SAowNumAss o1/lxtures ' <br /> A/C—airhandlin units TWlet <br /> � Forced atr s tems Balhtub <br /> Gas Lavalo wash basln <br /> Water heater � Shower <br /> Ges fi lace IQtehen sink&dis osal <br /> Gas ran � Dishwashx <br /> Golhes d ar Gothes washer <br /> Re e hood Weter heater <br /> Exhaust fan Slnk servicelbarlmo ate. <br /> Heat um BackMow reventer <br /> Unit heater UAnai <br /> Boiler Drinkin Founlaln <br /> • Refii erafion Floordrain <br /> Woodstove Grease tra <br /> �uctin Roof drains <br /> Other Medical Ges <br /> SPRINKLER/SUPPRESSION SYSTEM Other. <br /> Number of Heads �� <br /> 1 hereby eertly th�l 1 have nad and ezamined thiz applialbn and know lhe eame lo ba true and cortscl.NI provfabne o(kws aM ordUuncss 9ovemMp <br /> this lype ot work vAI ba rnmplied wilh xTxlher epecifrod Mroin or noL Tha pran6np of�pemul does rwl preaume fo 9������Y to vblaM w uoxt <br /> Ih�provlslon ot any olher aUle or loal law re9uhtlrp conttruUlon or the performanu of co�sWcllon.That�am autho�zetl by IM ovmer of tNs prop�rty <br /> lo psAo i ths�+ork r xfiich aOP�iulion is made and I comply wit lhe Shb Contractors Law 78.27 RCW and 288200 WAC <br /> . . - ��� <br /> O orl lh en turo Date (Revisetl?ROff) <br /> � <br />