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From: 01 /7�/2012 12:16 rt97 P.002/002 <br /> � 77� ��n <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D Cedar St., Everetl,WA 98201 -425-257-8810-FAX 425-257-8857-wv,nv.everetN+a.org <br /> APPL1CAi�ONS ARE AGCBPTED FRON1 8 AM TO 4 PM <br /> SITE ADDRESS: �-, VRO{`CATY7A%M PERMIT M <br /> �I23 ��cF��v,ev� vv.� p��, -7��C�c�� �,<�lo - <br /> LCGAL fo�newconstm[tion- Shon PlaVsuDmvicion Lol No. �aRach cupy nl lo� legal tlesuip�ion; <br /> OWNER�'-t'�C.41 �+\ "G L 1 — PhoneiE.mail �-iv��'j. �jL�� . <_)�ZL{ <br /> 1 l� /� o <br /> naeress L1 2.� ��(.�t�,,`�P_VJ 2 ury�staie2�n � 'C���-� ' +�\ '''j o�.O,�j <br /> CONTRACTOR �'V Q �l L&I Lic.71 I I G IN 1 S C <br /> AtlOres� I�� t�L ('�Ve. �� '(' Q,{1 1q� J3y P�ane!Cmuil 'L 31p.7 <br /> TENANT BUSINE55 NAME CONiACT FOR [RMIT <br /> J'ulie Ca5 -�f �25. (a3(a•7 <br /> Phonele�ma.i� �l. C�. � 1�Q-'C��'�t Q . C1�Y✓1 <br /> BUIL7ING PERMIT APPLICATION cor+rHncT PH�ce or woRK__�i_ ��2S� -- <br /> [xislin9 Uso 01 Uwltling�]- ?� - 1�+��_�- ___ HLf�f SOURCE�. <br /> Pwposed Use�o1(Quilding Gns E�erinc� Omer__ <br /> Duilding type: (�.Single family _Duplex_Townh�o/use _Mulli-Family _Co��mercial <br /> Typn of projeU: _New _Atldition _RemoOel ^Repair_T.I.�Sign_SFrinklcr_Uemolifion_Change ol Use <br /> Descriplion o1 Wotic(a00H�onal spece provide0 on tha Dach): <br /> �e,mc3.�� ���{�1�ce el<��_�; �� vJ a�l-E(l ��s_�i l�(, <br /> Have you s[arled workmg withaut a permll7 _Y[S ___NO <br /> R!ECHANII:AL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoolProJrcC _Nxw,_Addn _Alteration_Rnpulr TypeolPraJecC _Now_Atltln __Alte�albn Ruyav <br /> Show NuniLer(MJ o/O�roins Show NumDcr(pf DI O�fwes <br /> —T� A/C-auhaetllin uni�s loilet <br /> � Forced air s stams OatMub <br /> Gas '� in Lavator wash basin) <br /> Walen c�ater y Shower <br /> Gas�ueplacn Ki(chen eink 8 di5posai <br /> Gac ran e � Dish�+ashc� <br /> Clothes tlr er Clolhes wesher <br /> Itan o hoo0 VJaler heater <br /> I [xhausl fan Sink servicNbaUmo /etc. <br /> Heal pump � Oackflow mvenlar <br /> I Uni�he:,ler I Urinal <br /> 13oi�er Drintin f°ountain <br /> RMri cralion I Floor tlrain <br /> Woodslovo Greasrt Ira <br /> DucUn Rool drams <br /> Olher_ tdetliwl Gas <br /> SPRINKLER f SUPPRESSION SYSTEM ' Other. <br /> � Numbor o(Heatls � Othor: <br /> I hpreEy certity thaU hnve reatl antl ezamined tnis aFP�icaticn anG Anow Ihe some lo be We an0 corred.All p�ovisions.Iaws anC orCinances gaveniln� <br /> t�is lype ol work wtll pe rnmo��etl wllh khelher speaOeC�eteln or not The qrantinp pl a permit ticec nol presume lo qWe a�ihorily to vlo�ale or fancel <br /> 1�P p/G�iSiJp DI apy U�hOI 61BIU U/IOCdI Idw fepolBhOtJ CAIgI�Utl�00 OI l�C p1f10fTdnLO 0/(pp51NCU0�.Th01 I Brtl 811IhOfi[BE bY fOC ONnO!OI Ih15 OfOPClly <br /> ��venorm iha vArk lor whiU apo��calion Is mntlE ane 1 comply vn�h thx State Coniracturs Law te D HCW ane'.P5.^.00 wAC <br /> I <br /> 9 G�/J'� — ��2��-�/".� <br /> � nor/AulhorizeOAgenl�lgneluro /—� palc (Fm•isc.]:Gu1;1 <br />