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06/03/2011 PRI 9106 PAX 2063206568 Prov. Campus Admin. ®002/003 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUP!_UMBINGIS IGNIS PRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Ceder St., Everett,WA 98201 -426-257-8810—FAX 425-257.8857—Wy1W.ever-3 a.org <br /> APPLICATIONS ARE ACCEPTED FROM a AM TO 4 PM — I/ <br /> SITE ADDRESS: S PROPERTYTAX# PERMIT# ` <br /> Ll,, <br /> LEGAL for new eonatrurhmn Shod PleVaubd MflOh_ Lo I No� (armh ropy of long legal deimpl ion) <br /> OWNER o -Mall <br /> ddmee PS 'e=' GtyrSlatNLp (,,> 1.1 SLrP <br /> CONTRACTOR <br /> Addrets Q PhonNEmajl 4zs <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone;2•mOk 7-5 <br /> BUILDING PERMIT APPLICATION ICONTRACT PRICE OF WORK f(OV <br /> Existing Use of Building HEAT SOURCE. <br /> Proposed Use of Building Gas Eroctnc char <br /> Building type. XSingle Family —Duplex_Townhousa Multi-Famlty _Commercial <br /> Type of project: Y New V, i� <br /> A _Remodel _Repair_T,1._Sign Sprinkler_DemohIIon_Change of Use <br /> Desuiptien of Work faddttnn l spafya provided on the Batu <br /> �k-vt 31ew\\A•�l•ti �+ L.fOaZ b,,Cvt,ln` SaoJe- a s 1...c.t sb�2C l iere.�a..,-�/) <br /> Have you started working without a permit? _YES 4NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type or Proj"I: XNaw_J1ddn _Alterallon_Repair Type of Project; _Nm_Addn __Attention_Repair <br /> Snow Number of fixtures Show Number of RATWes <br /> AIC–olr handling units = <br /> Forgesitf stems Bathtub <br /> Oa <br /> i ing Lavatory(wash basin) <br /> Water healerSChehow <br /> enr <br /> Gas fireplore K@sink&disposal <br /> I Gas nn a Dishwasher <br /> Ctolhaa 0 ry I Clothes washer <br /> Fianna hood Water heater <br /> Exhaust fan Sink(servlceAtarrmo rola.) <br /> Heal pump Dackfew preventer <br /> Unit heater Urinal <br /> _ I Boller Drinking Fountain <br /> eln eratlon Fl <br /> oooor draln <br /> Wdstove Grease tra <br /> Ductlh Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> Number of Heads Other. <br /> I hereby Certify that I have read and exanllnea this application and know the tame la be Inst and Correct.AN provisions of Iowa and ordinances governing <br /> Nis type a work will be complied whit whether specified herein or MI.The grentirg of a porma does not presume to give authority t0 vrdato or cariGl <br /> the provialon or any ether stale or beat law regulalMg conalrudion or the performance of constructiot,That I Om authorized by the owner of this Property <br /> to perform Ile work for wpich appl Callon Is made end t comply won the also Contractor$Lew 16.27 RC W and 206.200 WAC <br /> on,�%sa4donoriallid Ag nl Signature v eso (Revised 212011) <br />