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From: 04/^'/2012 1D:37 :�sa P.002�002 <br /> �,�3r�Z� <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPT[D fROM 9 AM TO 4 PM <br /> $ITC-ADDRESS .�^^' (� PROPENNTA%p PEHMIT N - <br /> L't f'1�,1G e'.(' �C�� . 4',C�' ��'� 4i00 <br /> LEGAL fo�new conslrudion'. Slwrt PIaV6�btlivision Lot No._ W��+ch copy ol lanp lepal acs:nptlon) <br /> OWNC-R L� ���� �rS� Phone/C-mall �- 1 �'a�s� <br /> AOtltos. I��� u�t,,��l V�- Ciry/SlatelZlp � �`��1 7 �� <br /> CONTRACTOR �'v Q �- L&I Lic.#` I l C IN "�� -��G <br /> nodress `�9� 132� A�e � �� �� W V3`1 v�aneiEmail Q , �y,p, / <br /> TENANT BUSINESS NAME CONTACT FOR ERMIT 'I,LS �3� 7 . <br /> �ulie Cas�{ `i <br /> Nn�„�mma,� e a-Ec-l�t�.ea'�.es�'1 <br /> BUILDINC PERMIT APPLICATION CONTftACT PRICE OF WORK_ <br /> Ezlsting Uso o10uiMing ��dC'-I1C'� __ HEAT SOLIRCE: <br /> Proposed Uso 0_1 f�uilding Gas Eiecmc _ other__ <br /> 6uilding type: j� Singlo Pamity _Duplea_Townhou e _MuII6Family _Commercial <br /> Type of project _NQw _Atldition _Romotlol �Repeir_T.I._Sign_Sprinkbr_Demolition�Change ot Use <br /> Uescription of Wotk(atltlit�onel space provlCed on fbe Dack): <br /> I��M t�s�� t�{�� �LC� Gi RS �,.� Cl�c�( �2�-�� <br /> Havo you startnd working wilhout a permit7`1 YES ___NO <br /> MECHANICAL PERMIT APPLICATION PLUMRING PERMIT APPLICATION <br /> Typc ol Pro�ect: _Now_Atltln _Allorallon Repalr Typo of ProJe:t. _New_Atldn _AllereUon_Repalr <br /> Show NumDor 1 0/IiYlurvs _ Show Numbrr(tl)o//inmres <br /> � A/C-air handlin units Todel <br /> � Forcod air s stoms Aalhlub <br /> Gas i�in Le+alor�(wash basin <br /> Wnter healer Shower <br /> Gas lire lace Kitchen sink 8 disposal <br /> Gas ran c Oishwasher <br /> Clothes d er Clolhes washer <br /> Ran a hood Waler healer <br /> Exhausl tan Sink servite/Uai/mo fetc. <br /> Heal um Backflow prevenler <br /> Unil hcaler � Urinel <br /> Doiler Urinkin Pountain <br /> Rolriqeration Floor drom <br /> Wootlslove Groas�Ire <br /> DucUn Rool drains <br /> Olhei Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM otncr: <br /> � Number of Heads Other: <br /> I hereby certAy t�at I have read entl examined lhis aD����alion antl Anow ttle 9ame to bo lrue anC CUtrect.All p�Ovislans ol law5 and urtlinence6 B���rning <br /> th�s type of woik w�n Co mmpLetl Hilh�.hcl�e�spttiOM�c�ein or not.T�e pranlinB ol a pertnll tloes rot presumo to give aut�onry�o viotulu or wnccl <br /> t�e D�ovislon al any ol�er slale or loWi law reguloting consWclion or Iha pBrlormanCC oi con9lNdiaR Th01 I am authorizeC�y U�e owner of Ibia pmpeny <br /> to porlortn lho work ior vfilch�DDIi[atlon Is maEe anE 1 compty WIh Ihe Slate Conlrectms law 1B271iCW en0 2P6.200 WAC <br /> nerlAuthodiatl AOonl gnelu�o ` ��e (l2ev�seo:l20f f) <br />