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' � � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGI5IGN/SPRIfVKLER/DEMOLITION <br /> CITY OF �VERETT PERMIT SERVICES <br /> 3200 Cedar SL, Fverett, WA 98201 425-257-8810 FAx 425•257-8857 w,rnv.everettwa.org i <br /> �a 3-�S <br /> SITE ADDRE55: �� o��PEa7V TAx n UrcCl P 1 IT a <br /> 5 DI Eve��(`e2��.�1�_ I DOc�9 � 2�iaol 2-U 6 <br /> LEGAL lor nc+v con;tmU�on�. Shon PIaV;u�tln�smn Lol No. (altach m¢;n1 iong legal deccnOlion) s s� �5 <br /> OWNER Verelt 7_ � . PnaneiE�m��i �� 2 p <br /> naarr, 7 Q GryiStaie�Z�a � �', W f�1 -L g� D <br /> APPUCANT:_O+vner Owne�sAgent Connactor Conlraclo�sNqenl _TenanUm�;�p,a,q�+��eva!aa�scmM1cmr.ew+mr.oe�»o+���ncsoace� <br /> CONTRACTOR �• •� > � S G. Slate Lic. » I�ERI C I,tJC � 6 cav e� . u�.tt a l itd � 3/Irj <br /> f� � ' PhonelEmaJ <br /> naa,e:, /j„ U. . ' g �' �1�522 bU-H 3- 096 Cr'C ' yhNCl�..ne <br /> TENANT 6USINESS NAME CONTACT FOR PERMIT <br /> � �m <br /> f µ4}�}- f22eoe1S�'2efva5 PH: Add•�34-4�{} rw,t Z �auA <br /> /AYu(`Ll C � AC} C Phone![�m�iIFL�U� C ' GM •he} �1� <br /> BUILDING PE MIT APP ICATION CONTRACTPRICEOF WORK �U, GUd __ , <br /> Existing Use ol Building ��� HEAT SOURCE: ` <br /> Pwposed Use ol Builtling�_y1jL0�G«-1 �14�..�1''T'1_L� Gas Eieuric Omer <br /> Bwiding type: _Single Family _Duplex_Townhouse _Mwt�Famdy Commercial <br /> T e of ro�ecl: New Adtlition Remotlel Re av T.I. Si n S rinkler Demoldron Chan e ol Use <br /> DESCRIPTIONOFWORK(aed,no�aisoecep�o��dedon�neback): Tenqn� x,,,,P�Ve+r�e�+ � G `�rm4'�" <br /> I�aak �nl-o a Gh'�"rop�G-��c Offce . lar-ea o� u.arFt 2�-�oa 5F. <br /> tiU G�arc�e ;n GcG�,�4r��, — EIBc+�r1c51 oirt� +�lPl-},Gn �ca! d�P.�crr� `.+.�b'n;�-a�. <br /> MECHANfCAL PERMIT APPLICATION PLUMBING PERMIT APPLICATlL1N <br /> Type ol P�oject: _NEw_Atldn _Alleralion_Repair Type ol Pro�ecC _New_Addn _Alteratlon_Repair <br /> ShowNumbcr C o/(ifures ShowNumhcr p olfixfurrs <br /> A/C-air handlin unils Toilel <br /> Forcetl air s stems �athtub <br /> Gas i In Lavalo wash L•asin <br /> Water healer Shower <br /> Gas fire lace Kildien sink A d�snosal <br /> Gas ranqe �ishwasher <br /> Clofhes d er Clcthes washer <br /> Ran e hood Water healer <br /> Ezhausl fan Sink service/badmo letc <br /> � Heat um Backllow reventer <br /> Unil healer Urinal <br /> Bailcr Drinkin f-ou��lain <br /> Refn C�a�ion Floor drain <br /> � Woodstove Greasclra <br /> DuUin Roof drains <br /> Olher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Olhec <br /> Number of Heatls Olher: <br /> I nMeGY«rt�ly Indt I navc read an0 e.dminea 1ni;appi¢aUon anU know InC same lo be We anU conect All provisionz ol ldw.Jntl o�A.nances 9aveming tbis type olwork wiA Ee compl <br /> .v.tl�nTelne�speofiea herem or nol 7he 9rdnt�ng ol d pe�d aocs nal p�esumc lo givc autnonry lo viol.l�e or cancel lhe pmns�on o1 any al�cr slalc or loWl Uw regWabng�onSVucuon <br /> Thal l, auMonzeU�y tt+e owner o�Ihis pro0 J7�o p°hortn ihe wo�h�or vm�c�aDO�'��aCon is made anE I mmOry��h NP Slale ConVaclors Law 18 77 ftCW anJ 296100A WAG <br /> —�nrv� � �� �2� -�5-- I`i' ' �;i, <br /> OwnulAulhorizc gen Signature Dale (Rev�sed oiz01�) �� <br />