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06/28/2012 THU 18: 34 PAx 425 487 652G Nortcreek Roofinq m002/003 <br /> PERM!T APPLICATION <br /> BUILDING/MECH�iNICAL/PLUMBING/SIGN/SPRINKIERIDEM/OLITION <br /> CITY OF EVERETT PERMIT SERVICES b —�3G �I L <br /> 3200 Cedar St., Everett, WA 98201 425-257-6810 FAX 425-257-E857 w�w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED f-ROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX q RMI7 p <br /> ti •� _ <br /> LEGAL for new constmcliorc Short PlaUsubdivision Lot No._ (atlach copy o�bng legal desvipticn) <br /> OWNER L',`(-'(l PhonelE-mail <br /> Address � CitylState/Zip -1 � <br /> APpLICANT: OwnCf ON'neiSAgCnI�CoNtaclor COnlfaCloiSAgen1 Ten�Nlmv�ipm�ttalelterolmnsemirom�M1eoxcenoao��ntuinretpeca� <br /> CONTRACTOR �� � l 8 I Lia N '(� COE Dus.Lia iF <br /> Address �`� <br /> � e�Emaii `125 -�V83- �IBr �� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT�/� � <br /> SU�-�-� �LI 1�� <br /> Phone/E�mail <br /> BUILDINGPEP.vi1TA:'PLICATION CONTRACTPRICEOFWORK �v3�� n 7 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use ot Building Gas Eietlric_ Other_ <br /> builtling type:�Single Family _Duplex_Townhouse _1.lulti-Family _Commercial <br /> T� e of pro'ecC New Addition� Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTIONOFW['/ORK(addilionalspaceproviCedontheback): � �y�. <br /> �r - O`tr � LL��N.0 �'sf C:UM�OSI�tPf� �}" `f�P��0.c-2. I,v\ l �'l <br /> compo���-��ot� - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typoo�Projoct: _New_Atldn _Alferatian_Repair Typeo(ProJacl: _New_Atltln _Alteration_Repair <br /> Show Number(p)o/fix(uros Show Numbcr(q)o//ixtures <br /> I AIC-air handlin units I Toilet <br /> ; Forced air s stems i Balhtub <br /> � Gas pipin Lavato (wash basin) <br /> i Wale�heater I Shower <br /> j Gas(ire lace i Kitchen sink&tlisposal <br /> i Gas ran e � Dishwasher , <br /> � Clolhes d er Cbthes washer <br /> Ran e hood I Water heater <br /> Exhaust tan Sink service/bar/mo letc. <br /> � Heat pump Backflow reventer <br /> Uail heater I Urinal _ <br /> Doiler I Crinkin Fountain <br /> � Rf.tri eration I Floordrain <br /> I W��odstove Grease Irep <br /> Ductin I Roof drains <br /> Olher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other. <br /> I lie.e�y cerldy t�ot I Imve reatl anG esaminetl O�is nppGwiion ana know Ne seme�o be I�ue anC cqrtetl.AI;wvii�ons ol Wws antl or�inancos 9oveming IAis lype ol.mik wA Oe compEeO <br /> w;1�wnether speafrea nerein or noL Tlic graNin9 0l a permM1 Ooas no1 presume lo give aulnonty lo vrolale or can<M Ilie F�ovision ol any al�er siate or Inral Nw regulaliig con6lmqion <br /> That I nm auliionzea Ey Via awne�ol Inls property to pcAorm the wmk br w�iUi aDplicalion is ma�e anG I comply wit�I�e Slale Conlydclore Ww 1627 RCW mW 238200A WAC. <br /> ��A� n � rn_c�. , r lo-a� -l� <br /> OwnedAuthorizod Agent Signature Dale (Revised FJ2072) <br />