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From: 11 '/2012 08:36 �757 P•005/005 <br /> � ' C�� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SI�NlSPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3?_00 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa orqZ <br /> APPLICATIONS ARE ACCEPI'ED FROM 8 AM TO 4 PM �I�' v—� Z <br /> SITEA�DRESS: vROPERTVTAXN M� � � I . <br /> l � <br /> LEGAL for newmnsirucbon Snon V1aVsubOivisian Lot No_ �alfecA wpy ollcng Iegai descriDtlon) <br /> OWNER 1 ((,(,� E? PhonelE-mail S � !t? �'� [] <br /> AOaress J� � V CilylStatelT.ip �\/�,Y� �l � f't _1 b � <br /> APPUCANT: Owner OwneYSA9enl �Conlraclor ContradofsAgenl _TenaN�m�.�vrc.ae.w��a�c�u�.�xo��uwo.n.noa�.on-.,m..o��+l <br /> CONTRACTOR � .Y1� (� � �'c(.�- L&I Lic.#1 SC�^�W��"���C COE Bus.Lic.# "�-j 7J <br /> 'L�O�` 1 JZ ve N'G� �� a!�C^ W C\ 1 OC,J�-- PhonelEmui m� ` si-�,.�a e.c4�en�1�(�«� v� <br /> Address . <br /> 7ENANT BUSINESS NAME CONTACT FOR PERMIT ��c��� ��}�(�� <br /> u2� 1�� <br /> PnonelF-mail � � � S 'L�y� <br /> BUILDtNG PEP2MIT APPLICATION CONTRACT PRICE OF WORK <br /> Exis�ing Use o(Builtling (� HEAT SOURCE: <br /> Pwposed Use of Building Gas _ F.lectric_ Othu�_ <br /> Duilding lype: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of rolect New Addition Remodel Repair T.�. Sign Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additionul space provitletl on fhe back)� <br /> 2( �. wt..�� � F.� "R�'{�f a.� �C�J Wo�.�e'�' �F���' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TyUe o:Profact: _New_Atlan _A��oration_Ropalr Type ol Profect: ShowUNumber�(MJ o1llrturostion_Repal� <br /> ShowNumbcrlM)o/IixNres <br /> � A/C-air handlin units ' 1'oilr.t <br /> i Forced air s stems Balhtub <br /> Gas pi in - Lavato (wash basiN <br /> Waler hua[er I Shower <br /> Gas fire lace ' Kitchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> Clothes dryer Clothes washet <br /> � Ran e hood Watar heater <br /> Exhaust fan I Sink(service/barlmop/etc.) <br /> Heat pump Backflow preventer <br /> Uni[hcaler Urinal <br /> 6oiier Drinkin Fountain <br /> � Rehi eralicn � Floofdtain <br /> � Woodstove ' Greasetrep <br /> � Duchn Roof drains <br /> Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> NumGer of Heads Other. <br /> I ne�uby can✓y I�et�I+m�e ixntl nnE v�omir�ea Inls a00�cnUon xntl AnowlOa eama tn oe imo a�U conecl.All prmbons ol�aw�nn�afGinunces po�ernv�p Inu typo elwo•x v.�Ii'ue comp6en <br /> willi wmdFor specRmO f�erein or Pnl.l0e UinnLnq ul a O��mn Ounx nol piesume lo p�vn oul0only lo violalo or ca�ce�Mv pmvnion ol eny 41M1or slple o�bcal Inw reBWnlnp romlmclAn <br /> Tl�ul l mu iull�orve�Ly I�c ownai uf Nle pmDeny lo pc�lmm Ilin woA loi ni�Kl�apPY':ntinn h mp�a xnJ i compy wR�Nc Sla'e Con!recicrs la«IB.2]RCW anG 19(Y Wn W�G <br /> v'� = i I D S '�( �- <br /> I uthorizo�AflentSlgnaWru Date (Revisetlfi?077) <br />