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Mar. 6. 2012 8:52AM EVERGREEN STATE HEAT & AC No. 1175 P. 1 <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES 3 — 06 —1 z <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everettw, .org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />SITE A R U n�-1J- <br />K V—qA ve— <br />PROPERTYTAI(N <br />PERMITII <br />I DOJ <br />LEGAL for newoonstruulom Short Plat/subdivlslon Lot No._ (allachcopyolkxg legal description) <br />OWNERZ O� <br />PhonelE.mail <br />AddressV'P(T� <br />City/SlalelLP <br />y�.,� <br />CONTRACTOR 4/ r A0 <br />L& I LIc. M V P V Q., 0 <br />(IDf\,y 1_I <br />Address 1' C.LI f- L Y'NP C.N V->` la'}' Phorb/Emall 5 - a5 a 3�1 <br />TENANT BU I E8S NAME <br />GUNTACT FOR PERMIT <br />Phorm(E-mail L—A -'�"J <br />BUILDINCrPERMIT APPLICATION <br />CONTRACT PRICE OF WORK 10 0Q <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building 12 081-1Z Electric other <br />Building type: _Single Family ]CDuplex_Townhouse _Mulll Famlly _Commercial <br />Type of project: -_, New _Addition _ Remodel J Repair_ T.I. _Sign _Sprinkler _Denrolillon_Change of Use <br />Descdp(lon of Work (additlonsk spaceprovided on the beck): <br />�jCiS Jr� U �r>c ce <br />Have you started working without a permit? _YES _\4/NO r <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Typeol Project: _New_Adda __Alteration ___Repair <br />Show Number Ig of fixtures <br />Typeof0ro)ect: ^New^Addn _—Allerstion_Repair <br />Show Number N)offixtures <br />AIC —elr hentlling unlls <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory ash basin <br />Water heater <br />Shower <br />Gas fir lace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Re.lge hood <br />Water heater <br />Exhaust fan <br />Sink (servke/berlmopletc.) <br />Heat pump <br />Backflow proventer <br />Unit healer <br />Urinal <br />Doller <br />Drinking Fountain <br />Ref eration <br />Floor drain <br />Woodstove <br />Grease Ire <br />Ductln <br />Roof drains <br />Other l <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby ceNfy that 1 have teal and examined Nb application and know the same to be We arW correct. All provisiona of Laws and ordinances governrg <br />Nis type of work will be complied with wtrelher specified herein or not. The gren8rng of a permit does not presume to give suthafry to violate or cancel <br />the provision of any other stale or local law regulating construction or the perlormorwx of eohsuuceun. Thai I am euthodzed by the o w o(Nls property <br />to perform the work for which applIcanon Is made and I comply vilth the Stale Contractors Law 18.27 RCW and 296.200 WAC <br />co <br />GAIW1 <br />a <br />-I <br />a <br />OwnerlAulhorbad Agent <br />Signature <br />Date (Revised=ff) <br />