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07/03/�013 w6D L5: 20 PAX G25 G87 G5�4 laortcreek Roofing d002/003 <br /> �� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everelt, WA 98201 425-?.57-8810 FAX 425-257-8857 v.nvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM11 � `�� `�3 <br /> SITE ADDRESS: � � PPOPEflTVTA%!1 P 71T p <br /> �-a <br /> LEGAL tor new consWctia¢ Slrod PlaUsu6divislon Lol No._ (atlach copy ol long legal descnplion) <br /> OWNER - � f PhonrlE�mail y �1 • 5R <br /> Atldress � r � � CilylStalelZip � <br /> 11PPLICANT: Owner Owner'sAgent�Contreclor ContractofSAgenl Tenant(m�mn�o�+eamr.,icimnwreiromm•o.�.�enoao�.ca�nmeioa�rl <br /> CONTRACTOR NO'C —1/�' 1 <br /> ' L&I Lic.# q� � COE Bus.Lia N q <br /> Fddress �� 'a � � � q ' onelEmail a5•� � ^ 1'"1� l <br /> TENAHT BUSINESS NAME CONTACT FOR PERA7IT <br /> SveC�.(�'1��c.re��r�' � �c� . �o n'1 <br /> Phone/E•mail <br /> BUILDING PERMIT APPLICATION cONTRqCT PRICE OF WORK '� <br /> Existing Use of Buildin� HEAT SOURCE: _ <br /> Proposed Use of Building Gas_ Giearic__ Otncr_ <br /> Buildinglype: _SingleFamily�Duplex_Townhouso _Mulli-Family _Commercial <br /> T e of pm'ecC New Addilion�+ Remodel Re air T.I. Si n Sprinkler Demolilion Chan e of Use <br /> DESC RIPi'ION OF W ORK(addifiona�spaco provided on the bacei:, <br /> �-cev_r o-4S� ex�5��� u�mpo5�-�vn a- re-r-�o� v.���11 <br /> wm�i�\-�`�rn� rcx��n� , c�rV.., r�\uc� S\��1',��� i �- ro�Eer� . <br /> MECHANICAL PERMIT AFPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofPro)ecl: _New_Atldn _Altemllon_Repair TypoofProJac�: _Now_Addn _AIlurnlion_Repair <br /> SfrmvNum6cr(p)alfixfures ShowNum6or(A olflxfwes <br /> A/C-air hantlling units Toilet <br /> � Forcetl air systems Oalhluh <br /> � Gas pipinq Lavalo (wasn basin <br /> Waler heater Shower <br /> Gas 5replace Kilchen sink&disposal <br /> Gas ranqe Dish�vasher <br /> Clothes drver � Clolhes washer <br /> Ranqo hood � Water heater <br /> Exhaust fan - Sink(servicelbarlmo letc. <br /> Heat ump i BackOowpreventer <br /> i Unit heatcr � Urinal <br /> [3oiler ; Drinkin Fountain <br /> Refri::,�alion I Ploordrain <br /> Woodstove Greasa trap <br /> � Ducting Roof drains <br /> � Oiher ! Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM i Other. <br /> � NumberofHeads �� Olher: <br /> I nereby conrty Nat I have�ea0 ana okaminea lnis epp!icalion and w�aw U�o samu io Oe we ona coneU.Ail pmvisions o�lavrs antl oNinanus 9oveming Ihis y�po ol wo�A w:ll be ccmpfeJ <br /> �v.lh vr�ot�er spedficd�etein or nol.Thn q�antng d a pertnh Eoos nol pmsumo k pive nu1�ONy tu viala�c ar wncM Iho pwvisian ol any ot�et elale or bwl la�r regule�ing consWcuon <br /> tlial I am aul�oNeC by No ormar ol NIs ptopatfy lo poRotm Nu�wik lor wt�kli apple�lion�6 metiv er�J I:ex;y wih the Slale COnlraclers Law 1027 RC W nnC 25�1a^P.\NAC. <br /> .���a� 1�. �'�c�.w�.. '�L-3 -13 <br /> OwnerlAulhorizod Aqoal Signoturo Dalo (Revisetl cR07:) <br />