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From: 05/""�2012 13:50 *870 P.0021002 <br /> ��� � yoo <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF LVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everelt, WA 98'L01 -425-257-8810-FAX 425-257-8857-www.everethva.org <br /> APPLICATIONS ARE ACCEPT[D FROM 8 AM TO 4 PM <br /> SITEADDRESS: r�2 ' ��`, v.1eV� vROPER7VTAl(u li <br /> 'J J L-� o" 'S DO00?�20C� S "OS -�j <br /> LEGAL/ornewwnslmction: ShorlPleUsu�tlivision LotNo._ (attachcopyollongle9altlescnption) <br /> OWi�ER��\ h nTC�'- (1 P�onc/E-mail � � � o-c� � <br /> AJtlress � � ' 1'q 1 h1,` � CityfState/ZIP ���\� 1�J A 1 �� <br /> CONTR/1CTOR 1'VQ, e L&ILic.# IIG • YV � C <br /> Atltlrass 1�� I�L ��Ve. � �� � W ��� PhondEmeil 3�,7 <br /> TENANT BUSINESS NAME C�ON,TACT FOR ERMIT 2S (a 3(0�7 <br /> J ulie �'[lS ic G � 5-�-wa-{e-rl�e a •G�'1 <br /> PhonclH-mail <br /> BUILOING PERMIT APPLICATION CONTRACT PRICE OF WORK � � <br /> Lxisting Usa of[3uilding �'J � G� HUT SOURCE: <br /> Pwposed Uso ol 9uilding Gas Ele.nric_. Omur__ __ <br /> 13uilding ty0e: �Single Famity _Duplez_Townhouse _�dultbFamily _Commerciul <br /> Type of project: _New _Addilion _Remodal �Repair_T.I._Sign_Sprinkler_Demolitian_Change of Use <br /> Descripli0n ol Work(oddlflone!spoco provltlotl on(he back): <br /> R2m�v�.� y��\ aCe �cts W u�' 1�e ��-e-C'. <br /> liave you slartud workinB without a pormit7 _YES ^NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATlON <br /> TypoolProJucl: _New�Atltln _Alloratlon Repolr Typao/ProJecl: _Nuw_Atldn _Altoralfon_Repalr <br /> Show Num6e�(#)ol IlAures S/row NumDar(a)o//lr(ures <br /> NC-olr handlin units � Toilet <br /> Forcedeirs stems BathWb <br /> � Gas i in Lavalor pvash busin <br /> Water henler Showar <br /> Gas fre laco i Kilchen sinA 8 tlisDosal <br /> Gas ron e I Dishwasher <br /> Clothes tl er Clothos washer <br /> Ran e hootl I Waten c�ater <br /> Exhausl fan Sink service/bar/mo /etc.) <br /> � Heat um I 8ackflow prevenler <br /> Unit healer Urinal <br /> Boiler Urinkin Fountain <br /> Relri eration Floor drain <br /> Wootlstovo Grcase Irap <br /> puctin Roof drains <br /> Othor i Mediwl Gas <br /> SPRINKLER/ SUPPRESSION SY STEM ' Othcr. <br /> Numbor of Heads Othor: <br /> i hureby certity thal I have read ontl examined Ihls apPlicaUon ontl hnow Ihe same to 6e Iruo end cortecL AII provis�ons ol luws ana ortlinances 9�+erning <br /> t��s rypo ot v,ork w91 be compfetl wilh whclhor apedficE herein or nat.T�e pran6ng ot�permil tloes nol presumc lo give authnity to violate or wncel <br /> the provlsion cl any olher stale or local law regulating conslruction or pie petlorman.v ol cronsVucl!on Thal I am autherim�Oy Ihe owner ol��is property <br /> to pertorm tho v.ork for wfiich npD��cntion Is mado and I comply vAl�tAe Stotu Contacloro Law 7827 RCW ond 2BE20�WAC <br /> ���......JJJ1,�� �'a�'�u.�- 5f a� I i� <br /> Qy+norlAuthorizedAAent 9�»turo Date (Rovisetl2/7071) <br /> v <br />