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• <br />� <br />U <br />PER,�V#lT A,PPL�CATION <br />BUIL,DING/�III�CHA�IICA,L/�LUMBINGISIGN/SPRINKLEh/D�MOIL�TION <br />CITX OF EVER�'TT PERMIT SERV�CES <br />3200 Cedar St., Everett, WA 98201 �Z5�257-8810 FAX A�25�257-Sg57 www.everettwa.org <br />ADDR�SS: <br />rax <br />r# <br />��`�� %�— <br />GAL for new constructlorr ShoR PlaUsubdivislon Lot No. _(attach copy oQ Iong lagal doscrlption) <br />re5s <br />PhonelE-m0il <br />ANT: � O�nmer , Owner`s Agent �, COntraclor ____ COfltraCtOf S A�7E�lf �, Ten9�t (muet prWidn o lottar a1 eoneent Rom �ha oxmor lo co v.ork In lhe <br />AC70R � State Llc, #�1�-N � � ' Bus. Lic. iF % <br />�� W� L 1��.. � V' � L F-�f Phono/Emall G,Y U'i- n" <br />�� l/�� J��.��5 �` <br />Phone/ER1ail ' �Z�j-��j�" <br />BUILDING �ERMIT APP�,�CATIO�IJ CONTRACT PRIC� OF 1NORK 1�1., ' �'I <br />Existing Use af Building NEAT 50URC�: <br />Proposed Use of euilding Gas Electflc oche� <br />Builtling type: _ Singlo Famlly u, Duplex Townhouse � Multl-Family _ COmmercfal <br />T��e oF projoct- New Additiorl Remodel Repair T.I Slqn 5prinkler pomolition_ __Chanqp of Use <br />DES�RIPTION OF WORK (additrona! Rpaca provldod on fhe beck): <br />�,.e�1,�.ca �,��v,�. v� i�� e,��,vl I� . �U e�c,e, -Ec�e�� <br />�,, .� <br />2 � v`� � <br />MeCF��AM�I�CAL PERM�T APPf��CA'M"��N <br />ot Project: ^New�Addn �Iteration _Repalr <br />Show Number # of flxtures <br />FJC — air handlin units <br />Foroed aif s stems <br />Gas pipin <br />Gas fir <br />Gas fa <br />r <br />Unit <br />� Other <br />SPRINKLER / SUPPRESSION <br />Number of Heads <br />p1.UMB��IG PERMIT A�PLIC,ATION <br />of ProJeCt: _N9w�ddn �Alts�dtion �Repeif <br />To <br />hower <br />;tcnen <br />Slnk (; <br />Backfl <br />F1 <br />Medical Cyas <br />Other; <br />I hn�by caHly khai I �ave read and axemfnvd thls eppllcatlon antl k�aw Ihe eeme ro be trun nntl correcl. All provleiona o} law3 �ntl ortllnances govemlap Ihla �p� ot work wlll he compl <br />with whether apecmed Itnmin or nat. Tho granNnA � n permlt doee nat presumo to glva euthar1ry ro vlotata or cantcl (he provlalon ot any othQr atAt� of locnl Imv repulating canslructlon <br />Th�t I c,m autho�izf��Dy the o r of I�Is DroDonY �o per}ortn the worh fot�+tlich appllcatlon Is mndo nnd I cemply wlth Ihe Stets GOrltfEl[tolta l,nw 10.27 RCW and 296,70oA WAC. <br />� 3 �5 <br />Owncr/Aukhorizetl Agent Sig akure Data (Rovlsed �1�1016) <br />