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FROM :Ever9reen State Heat & Ri� FAX N0. �4252596660 Rpr. 26 2011 10:33AM P1 <br /> PERMIT APPLZCATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CI7Y OF EVERETT PERMIT SERVICES y—� �j ` �I <br /> 3200 Cedar St., Evefetl,A��CATION8 ME ACCEPT ED FROM 8 AM TO 4 PM57_��eVefetlWa.0�9 <br /> ROPER7YTA7(M ��MRM _ ,,` <br /> 9ITE ADDRE83: �� � L 1 �,.�� � •,� <br /> _� <br /> LEGAL tor new constn�clion: ShDrt PleUsubtlivisiun___. <br /> Lol No._,._ (���ach copy 011ong IBpal dascrlDlkn) <br /> � PhonelE•meil L ���' �� � � <br /> OWNEft L �� � _ t . (� I � <br /> 3 , � cityl3cale2�p C/Y�'11LA�• — I��t.1 <br /> n,ess '� � 1 <br /> CONTRACTOR � ✓� � - � 1� L&I Lic.d ' �PVC S ' �I��� + <br /> ,� Pnone/Email �O`�.�� � �I ' <br /> Otlress �- �, � ON CT FO �.RMI <br /> T T B IN NA - <br /> ,�S' honelE-mall � <br /> 6UILDINO PCRMIT APPLIC4TION ONTRAC7 PRICE oF WORK ' <br /> GxisNng Use ot Building_�� `�='��-��SL_. . HEAT SOURCE: <br /> !� �NrYtO � . Ges Eiac:nc Olher __ <br /> Propasod Use of �Iding_.� . �— <br /> 9uumnp rype:�Single Femity __Duplex__Townhousa __Multi•Fnmlly _Commercial <br /> TypedprojocU , _New _Addltlan _. Romodel ,_ftepair_T.I._._Slpn_Sprinkler_Dertwlitlon_Chenge ofUeo <br /> Dnscnpllon of W ork(nddlt'annl spxe(Yovldod on fnu Wck): <br /> �--p lacu �,-�--C.' <br /> Have you ataAed working withoul a permit7 _YE3 �NO <br /> MECHANIC/1L PERMIT RPPLICATION PLUMBIN6 PERMIT APPLICATION <br /> ypo of Pro��ct: _Naw_Addn�Altaratlon_Repalr Type of PIDJeCt: _N6W_Adtln _Altofatlon_Repol! <br /> SnewNum�er u�/uh�ros ShawNumbor M d/trfums <br /> AIC—air handling uails Tdlet <br /> Forcetl air s etems BathWb <br /> Gas i i Lavata wash basin <br /> Water heate� Shower <br /> Gas fire lace K�lchen slnk&dlsposal <br /> Gas ran e Dlshwasher <br /> CbtMs d er CIolheS Washer <br /> Ran e h0od W ator bealer <br /> Exhaust len Slnk servicelhadrtw lelc. <br /> Heal ump 8xkflow revqnWr <br /> Unit lieater Utlnal <br /> Bdler Drinkln Fountain <br /> Retd eration Floor tlraln <br /> Woodslove C+ease tra <br /> Ductin Roof drains <br /> Other Medlcal Gas <br /> SVRINKLER /SUPPRESSION SY37EM other: <br /> Numbcr ot Hoads � Olher. <br /> 1 horohy conily Ihat I have reed entl ez�mineG Ihls appAcntian end know lha aeme lo be Irue nntl carreG.NI provieions of ievr and ortlinancec ywaming <br /> lhls type ol worlt wAI be comd�etl with whethBf 9pacifed hereln or nd.T�a gmnting ol e p9mtll doe5 frot presumY lo gtve aulhorib lo violeto or cencel <br /> Ihe pmviaia0 a(flny othor,tnie ar IOC211aw reguWlinp Con3lnmtion or l�a p2rtormence a1 conclwcUon.Thet I nm aulho�dtl 6y Ne ovmer of ihia prourty <br /> �1 nAa'tha work lor whlch applfcntian is made and I wmpty with tha SIa o Contradore Law 18.27 RCW ana Z�J92U0 WAC <br /> � �;�1.�ve�`., y—'�e�—� ` <br /> OWOedAulhorlxoJAgent6ipn {yh Dato (Reviand22071) <br /> Cl <br />