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11/10/2011 10:38 14257456404 ADVANCED INSTALL PAGE 01 <br /> � (. <br /> PERMIT L' ?PLICATION <br /> BUILUING/MECHANICAL/PLUIWBII�GISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETf PERMR SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8910—FAX 425-267-8857—www•everettwa.org <br /> APVL�CAiIONS AtiE ACCEPTiD F!!OM s AM TO��M -- <br /> SITflADDRE55: • PI�OP[RTYTAX� PE rtY . <br /> U�ym Pic l I I-p <br /> LEGAIfo�newcons�a��� ShoAPlaVsubdiviaion LolNo._ (attafJ�CODy���Glpddwaiptiari) <br /> pWNER !�J Phon�lE+nail •2- + 3 <br /> naaru. cnylsut.Rio 3 <br /> cONTRACTOR L G I llc.11 �� <br /> Addnu �V-.Jv � � ^'^��'�i 1 PhonvEm�il � • � <br /> T N USIN 88 coN p,c�V �cWCt �n'.�o�l r <br /> P�ontJE•meP � <br /> YUILDINa rERMIT APPLICATION CONTRACT PWCE OF WORK � <br /> Existinp Uee ot Buildlnp_ HFAT SOURCE: <br /> Pmposetl USe o�9u�lding Gae ELCVic Olhx <br /> Buildinp type: ',�SIngIG Famlly _Duple%_TaNmnouse _MuIt4Family _CommerGie� <br /> 7yp�o�p���; �,iJaw _Adtlltlon �Rsmodal _Rap7ir^,T.I._Sipn_SprinMef_Demolilion_Chanpe o1Uae <br /> Oescriv�on of Work(add�Nwa1 fAxe prorad on fhe Aeck7: <br /> H.ve you fterted����G�+���a P�^'H7 YES _.N� � <br /> MtCNANICAL PERIN�T APPLIC�TION PLUMd�N6 rERMIT APPLICATION <br /> Re ur TYG�olPtqen _N�r_Addn _Ahention,JN�Wir <br /> TypeofPrv��et: N�w_�Adn _AMratlol�_ P � S�.ryyTbv ofartunr <br /> $MwNumbw o�R�cWI�� TOile� <br /> AIC—eir handlin unils tlnub <br /> Forad eir s tems ��� �yth Desin <br /> Ou pipin ShOWM <br /> Water heeter Kncn.n unk da o�ei <br /> ee rc lace Ichwesher <br /> 6as ran . lothoo wuher <br /> ��d �(Qf�IMLt1 <br /> an e h <br /> wcllan Sink aorvicelberlmo e1a <br /> Heat mp ' Be nter <br /> nit healer Urinel <br /> Boilet Drinkin min <br /> RuM eration oor drein <br /> W oadaMve Greue in <br /> OucUn Roof tireim <br /> Other Medkel Ges <br /> SPRINKLER I lUPrRi8s10N YETBM o�nar <br /> Num6.r of Heads Other. <br /> I h�roby�rtify Ih�l I hive rNd end avmin�d lhls epd����an and knOw N�uma to be 4Y���d mmct.AA Drovision�o11N�s 7n0 O�di�vnosc po+�nAnO <br /> ihia typa ot v.blk u�l be compliW VMh whetMr ap�c�fiod�erdn or nd.Th�y'mUnq of�pxmit d0l3 nd Pn�urtr tv pN!�ulhdity��?.!o mU D�oWM <br /> the o�o+�+hn ot�ny oMar state w ioral I�w npWd�+y wnstruction or th�pnormanu o/wnNNrllon.TT�I I�m aulM�zed M <br /> to Ih��wrk for whi,h�ppliulion in mad!E�d I romplY wllh Me Sleb Contn�ta'f�!w 18.27 RCW�00:96.200 WAC <br /> � ��-� p�- �- �� �.11 w� ,��,��,,, <br /> OwnerUutho � gentSiO�+�M � �x. �,Ic.�� /� ^ _ ___ .L <br /> 47 Y J t'n{ �q.Cf YYKA��.� <br /> ��� 1 CI <br />