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11/29/2012 Ttau 15: 06 FAX ��^ City of everett permite <br /> mouziva3 <br /> PkuRMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLER/DEMOL(TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everc..t,WA fl8Z01 -425-257-bB10—FAX 425-257-6857—wvvw.everettwa.org <br /> ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> P RMIT X <br /> BITEADDRE9S; ^S �+_/C� H�Nt�p 1 1,. PROPERTYTAIfp O� ;'� I �I - �'�� <br /> (� �� A//!.pl//C_ y�—J I ' ' <br /> LEGAL fo�now canclrucUon; Short PlaVoubdlvlslon t�-LLSJ lilJ�}�Lal No.� (ellech cupy of lou9 lepal descrlpllon) <br /> OWNER L� Q � Q��/'--'�nCs PhonerE-motl qZs �U V '" S 2�� � <br /> Mdra66 �� C!Iy/51etGZlp �Vl/�1J17 � V 1�/! -I �+�✓� <br /> CONTRACTOR L 8 I Lic.# �� • 6 � � <br /> �'I� n •+ A.i�.. �C' �'� 3 PhonelEmall s.r2� / . �' 3 <br /> Addroee <-GU�� � �� NTACT FOR P@RMIT <br /> TENANT 9USINE S NAME A rn�I I,G , <br /> p. PhonelE•mell r r, Pblue <br /> BUILDINC3 PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> HtAI SUUl2CL': <br /> Existing Use of Ciuitding / <br /> Gas ✓ Ebtlrlt_ Olhor <br /> Propoced Uoo oi Bullding <br /> Bulldinglypa: _SinglaFamily _Duplex Townhouse _Mulli-Family _,Commerclol <br /> Typa of proiecl. _New ,_Addilion _Ramode� _Repair_T.L^Slgn_Sprinkler_Demolition._Chnnge of Use <br /> Descriplion of Wark(edd�donel spece provldeu a�the bacl�: � <br /> �ep�Q��e �D°� 9acr �fu-�ev�ac� u�/ I'�cv �1 �'; �a�(' R� , <br /> Havo you sWrted working wlthout a pormlt? _YES �NO <br /> M�CHANICAL PCRMIT APPLICdT10N PLLIMBINO PERMIT APPLICATION <br /> TypoolProJoCI: _Now,�Addn ,_,_.f�ltorallan_Ropelr rypeofPraJ�ct: ,_Now_Addn �ItrraUon_R�pslr <br /> ShowNumboflN olllxlurea ShowMnnbor(N)o/fiirtufea <br /> A/C—atrhendlln unita Toilel <br /> Porced nlr e atems OelhWb <br /> Goa I In Levnlo wosh besin) <br /> Water heatar Shower <br /> Gas Gre lace Kitchen slnK 8 dleposnl <br /> Oasr�n e Dishwasher <br /> Clothes d er Clothas washer <br /> Rmi c hood Watar heator <br /> Exhausl(an Slnk servlcc/Uer/mo ielc. <br /> Heat um Backllow rovonfer <br /> Unll hsater Unnel <br /> � 6oller Drinkin Founlain <br /> Rolrl orotlon Flonrdraln <br /> Woadslove Grense trn <br /> Duclin Root dralna <br /> Olhor IAedlcel Oas <br /> $PRINKLER I SUPPRESSION SYSTEM 0lher: <br /> Numbor of Headc Other: <br /> I herxhy certlfy Iliol I twve read and eYaminxd IIJa appllcalio�end know Iho eamo 10 Do InlO ond corro�L All provlslone of laws nnd ordlnnncoa povaminp <br /> t�ls lype ol work wlll be complled wilh whelher spoclflad horuln or nol.Tho prunllnp o(o pamtlt d00o not pre6ume lo glve authorl(y to.vlolpt0 or CpnCAI <br /> Ihe provlclon ol any olher atale ar locel law re8ulaling conelrudlon or Ihe parlormunco of conolructlon.Thpl I am authorized by t�o ownar of ttue Dfaporly <br /> to poAorm!he wak tor whlch ppllcallon Is made and I campty wllh lhe Steta ConlraIXure Low 10.27 RCW ond 280200 W�C <br /> c I�� (RevisadY20f7) <br /> pwnorlAUtherizndAponl pneWro D te , <br />