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PERI�tIiT APPL.tGATIC}N <br /> BUILDlN GIMECHA�iI�A�.lPLUMB1I�Gl�I�N/�►PRINKLER1t3EMClL1Tit�N <br /> GITY C1F EVERETT PERMIT SERVICES <br /> 32(lQ Cedar St., Everetf, WA 98201 425-257-881D FAX 42a-257-8857 www.�verettwa.org <br /> S1TE AD�E�, pROPER TAX It P <br /> C� t -t. � � 'g I `3t71� � - <br /> LEGAL fc7r new construction: Short PlaUsubdivision Lai Nn. (aitach copy oi long iegal description) <br /> OWNER �'" („_ U1'�C-�""t�.- t�, !(� PhonetE-maii '�,�� ' ��� ' �,{j � <br /> Adrieess �--� GitytStakeiZ�p <br /> APPUCANT: ___Ownar O�hner s Agent ___Contractor ,,.,.__Conlractor'S Aqent T2q8RI(mosC p�nv�ve a iF:nc�at conseni tresn�me crmer to�a wur;v�tee spaw�t <br /> CONTRRCTOR �,,ti1,�r�„avt^� State�ic.# C.`�t City Bus.Lic.#�ot �� � <br /> Ad�3ross� {)� �-i'^ �. �-.L �� V�O PhonetEa�aif ��a 's'� �'1 � ' �i"�l�3� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT q„��l� �.Mh�tt-�1 <br /> PhonelE-mail Q.�t'Yl�t-(..� . �.•A' <br /> BU[LDING PERMIT APPLICATlON GONTRAC7 PRtCE OF Wt7RK �'—�'� <br /> Exisiing U5e of 8uiiding �� � WEAT SC7tJRCE: <br /> FrQpos�d Use af Buil " [� Gas Eieckric Oiher <br /> Building type: Single Farrsily _Duptex�Townhouse ,�Multi•Family �Cammerciai <br /> 7 e nf �o"ect: New Addition Remodel Re a�r �.I. 5i n S rinklar Lemaiition Chan e of Usr <br /> DESGRiPTIQN OF WORK(additionat s�ace prov+decl a tne bac� <br /> ����s,►.�l � ��� s s ��...�- `� �'t�`'� <br /> MEGHANI�AL PERMtT APPLICAT1aN PLUMBING PERMIT APPLICATIClN <br /> Type of Project: ____New�Addn _AHeration�Repair Type of Project: „_New�Addn �Alteration_Repair <br /> Show Number tt of fixtures Shaw Number � of�xtures <br /> AiC–air handli� u�its Tail�t <br /> Forced air s stems g���f����a� <br /> � Gas i in j lavator tirrash nasin) <br /> ( Water heater Shower <br /> � Gas fire lace � Kiich�n sink&dis osal <br /> f G�s ren �e � Disttvrasher <br /> Ciothes d er Ciothes�aasher <br /> Ran e hood Water heaier <br /> Exh�ust fan Sink s�rvte�dbartmo letc- <br /> Heat urn �. $ Backflovo r��renter <br /> lJnFt heai�r �� � � U�irt�i <br /> Boiler � Drinkir� �r�uniain <br /> Refri eration Floor drain <br /> Woodstove � 1 Gre�se tr�� <br /> Ductin ! f�aaf drains <br /> ; Other M�dtcal Gas <br /> SPRINK4ER / SUPPRESSIQN SYSTEM � Other. <br /> Number of Heads � C?ther: <br /> I hereby c�rt�ty it�yt 1 have rearf and examined th�s aGpli�2lion�nd krrnw the 5art��to trfl�t�ue an4f correol AI{pravisdnn.y at laws ea�d nr�}VnFtrt�o�.:pavflrn�ng IhiS type aE wc�ric wFdt be ce�n�p <br /> �h whe�sther,pecifietl herem or not.The grantirtg�f a permit doe5 not prt�surne ta yive�ufharity t�viaSaie or cancel tku;provisran of any utNer state or loc.a�lew r�g5siatinr,�c:onstructian <br /> Tt��r i am acihiqr}���J by the own r af ihis prvpeny to perfotm the work for wh'i h applicalion is made and i compiy witM the 5,ate Gon;ractors Law 16.27 RC�tV and 29o.200A+/YAc',- <br /> . � .� �� �� <br /> � neriAuEhorizsd Agent Signature Dale (Revised 9!2(1�1•.,i <br />