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10/09/2012 TUE 10: 01 FAX --- city of everett permita �001/002 <br /> + <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION : <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3'LUU Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-0857—www.everettwa.org/� � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -� '7 `�Z <br /> SITE ADDRESS: 1 �iI f-\ �- PRO�?1 RN TIpXp D �"{,1Q%r G P R Z 1"'—v 7� <br /> � } <br /> LEGAL for new constroclion: Short PlaVsubdivision Lot No._ (allach copy ol long legal Cescription) <br /> OWNER 1���I�wr�, � �c Phone/E�mall �i !'7 _ ;31 z - �34�2 .�.^U - 3yi -vE,�" <br /> � <br /> Address ( l� Z S "'�L Vl G� City/SlalelZiP (� �. °.i. ,�.I.. r � ��-U <br /> CONTRACTOR � J ( [i vL� r C.L- L& I Lic.# CI � �� • l <br /> nadress � � (t L,ZQ��' ��-�-. cJ�} •t�'- �hnnelEmait HZS - `'� r-. '-'� �`�� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT I,_��-��V.{ �/�/G'l��/}i e.� <br /> . }- <br /> c <br /> Phone/Email '�?�S �� � " � � �� <br /> BUILDING PERMIT APPLICATION CONTRACT RICE oF woRK � � ��% � <br /> Existing Use of Builtlinc� HEAT SOURCE: , <br /> Proposed Use of Building Gas Electric Other_ <br /> Building rype: _ .'��e Family _Duplez_Townhouse Mulli-Family _Commercial <br /> Type of praect lew _Addilion _Remotlel _Repair_T.I.,_Sign_Sprinkler_Demolition_Change o(Use <br /> Description of Work(adddional space prorldeC on fhe backl: ,. � ' I <br /> ���'^ �Ct_(� C�(,L�S ')�.�1�1'1�C,�, t`J L'lG�C� ��� �, l�� l C ��1� �J� . <br /> Have you slarted working without a permil7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Profecl: ,vi�ew_AdAn ��terallon_Repair Typo ol Pro�ecl: _New_Addn _Altoratlon_Repair <br /> Show Number(0)of llxtures SNow Nambcr(N)ol(ixtures <br /> � NC-air handlin unils ToiIM <br /> Forced air s stems Bathtut <br /> (�as pipin Lavato (wash basin) <br /> Walar haaler Shower <br /> Gas tireplace Kitchen sinh&disposal <br /> Gas range Dishwasher <br /> � Clolhes dryer Clolhes washer <br /> Ran e hood Waler heater <br /> � Cxhuust fen Sink(servicelbadmoplMc.) <br /> � Heat ump Backflow reventer <br /> Unit heater Urinal <br /> Boilcr D�inkin Fountain <br /> � Re(ri eration Floordrain <br /> � \Noodstove Grease Irap <br /> � Ductin Rootdrains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> � Numberof Heads � Other: <br /> i he�eby cetlify Ihal I have read and examined this apP���alion and know Ihe same lo Oe lnie and correc�.N�provisions of laws and ordinances goveming <br /> ihis�ype ol work will Ue complieJ vnlli whelher specified herein or not.The p�anling ol a permil does not presume lo give aulhorily lo violale or cancel <br /> mc pro�ision ol af,y olhcr ototo or I xal Inw regulalinq conslmclio�or the poAormanco of conctwclian,Thal I am aulho�ixod by Iho o�vner at Ihic properly <br /> / !�perlorm the vrark Or wh'ch apP�icati n�s made and I comply with Ihe SI te Conuaclors Law 70.27 RCW and 296,200 WAC <br /> � ��� ,,,���,��%� ; , , ;;, : .�,=--� � � �� 1 � � <br /> �, <br /> OwnedAulhorized A90 1 I�jiialuro � Uale (ReviSed 2l2011) <br />