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Fro�n: � 03/�' '2012 11 : 10 M883 P.002I002 <br /> 5$O(D�o2 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98207 -425-257-8810—FAX 425•257-8857—vwvw.everettwa.oraT, <br /> APPLICATIONS ARE ACCEPTEO FROM!AM TO 1 PM �-I N ���' <br /> S T ADDRE63: ►Ro►ErtTv t�x� «. <br /> �,n 5+-4 002o I o o C� �I <br /> LE6AL Ior new ccrutruQlm: Shorl PI�V�uDOM�lon _lol No_ (attcch copy o�lonp lep�l Oowipifon) <br /> OWNER �c� �J�' �nondE-meil Cj � <br /> AOEre�� �y MG� V1 CllylSt�leZp Q�e �/v('� 2�3 <br /> CONTRACTOR rV(� L61Uc.N IlG • W S C <br /> AEOros� �L�{�� { UZ r1 ve � �� tM� W 1 PhaM�Emsll . / <br /> TENAH� U A CO AC RMI ZSI03�0•7 <br /> �lic as � .c� <br /> PhonMEmHI �(. 0. Q <br /> SUILDIN6 PERMIT APrLICATION CONTRACT PRICE OF WORK <br /> Ezislinq Use oi Buildinp � C� HEAT SOURCE: <br /> Proposed Usa ol BuilCinp Gee EieaNc ov�er <br /> 13uiidingfype: �SinpleFamily _Dupkx_Townh use _Multi-Family _CommerGal <br /> Type a1 projed: _New _AddNion _Remodel ,,,�,Repalr_T.I._Si�n_Sprinkkr_Demolitlon_Chanpe of Use <br /> Dascription of Work(etltlttrone/apace provltled on the beck): <br /> H��eyo�.ansdwarxi�ownno�e.a�in _rEs _No <br /> MECHANICAL PBRMIT APPLICATION PLUMBIN6 PERMIT APPLICATION <br /> Typs ol Proj�ct: _INa_AAdn AN�rNon_R�pdr Typ�ol ProJecl: _INw Addn _AllenUon�R�p�ir <br /> Show Numb�r o1/Ixfun� Show Number olllrfunt <br /> A/C—eir hanCtin unils Toibt <br /> ' ForceE alr� stams B�thtub <br /> Gt� i In L�v�to wash ba�in <br /> Welarheeter I Shower <br /> Gee�re lace KMchen tink 6 Gls tel <br /> Gat ran e Dishwa�her <br /> Clolhef d er Clothes w�shar <br /> R�n e hood W�tei he�ter <br /> Exheust fen Sink serWcelbar/m letc. <br /> Heat um BecMlow revante� <br /> UnH heater Urinal <br /> 9oikr Drinkin Fountein <br /> Refri eration Floor drain <br /> Woodatove i Greue tnp <br /> Ductin Roo1 drelnf <br /> Othe� Medical Ges <br /> SPRINKLER / SUPPRESSION EY8TEM otner: <br /> Numbar oi lieada Other: <br /> I hercDy cerlify t�et I hav�reaE en0 e�umineC ihle applinlion enE knowthe s�me lo be Irue end cmxt.All provi�b��of lews an0 ortlinarcet povemlrp <br /> Ihi�type of woilc vAll Dtr wmplleE wilh wf�etner�pedfletl hereln or not.'Te qranUnO ol�pertnit 7xa no1 pre�ume to pive�ulhoriry lo vb��te or cancel <br /> Ihe povision of eny other stcte or bcal I�w rpub6nq constnK,ylon or Iha perlomiance ot coneWdion.TMI I am authorizetl Dy the owner ol thl�property <br /> lo pe�orm Vie work for�Mich epoluUon 4 meAe end 1 comply wit�Ihe Slele COMndun Uw 1827 RCW��d 7D8 200 WAL <br /> ���'Y �� <br /> n�rlAuNoriz�dAgml pneture Dele (RevlaedT/5017) <br />