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P@RMIT APPi.ECATION <br /> BUlLD1NG J MECHANtCAL/PLUMBlNG!SIGN/SPRiNKLER 1 DEMOL1T10N <br /> Clz`!OF EVERETT PERMIT SERVICES <br /> • 8200 GEDAR STR�ET,�VERETT,WA 98209 <br /> (P)425-257-8810 � FAX�125-257=8857 ((�)everetteps@everetlwa.gov� www.everetkwa.gov/permits <br /> (�lue ar Black��nk OnYy PCease) P'ROJECT S1TS INN�ORMATION � <br /> p�a��cr s�r�A��R�ss:3003 W. Casino Rd. ' p120PERTY TAX#: <br /> 1.�GA[,for naw canstruction: Shwt P{afts�bd[vfslon �U�� �}��,3 Lot Na (attach cc�py of Iong legal descrlpfion) <br /> CON'i'ACT iNF�ORMATION <br /> OWN�R NAM�: The Bosing �o. T�RfANT NANI�(If CommerciaE):Baein <br /> OWN�R MA[L1NG AADR�SS: s�rneer P.�. BOX �7Q7 <br /> c�rv SG'�ttl2 • eTaYe WA . zir 98124 <br /> OWN�R PHO�i�: dWNSR BMAIL: <br /> GONTRACTQR NAME; General Constructian <br /> CONTE2ACTORADDFtESS; s��P.O. Bax 44 • <br /> �,n Mukiltea grn,�WA z�P 98275 <br /> CONTRACTOR PHO[�E: 425-294-6946 coNr�acroR EM,v�: <br /> CONTRACTOI�l,{CENS�#(REQUIRED):G EN E RCC9$402 Cl'i'Y Oi�EVEftETT�USINESS LICENSE#(f�t�U1REp): ' <br /> PRIINARY CONTAGT: ❑OWNER �CON7RAC70R ❑OTHER(PEease Speclfy) <br /> CONTACT NAM�: coNrac r�H�rtE:425-367-2143 � <br /> • Kari Hammer cor�Tacr�n�arz:�Cari.hammer�kiewit.com <br /> BUII.DIN�PBRMIT APPLICATIO�! <br /> �xistin Use of Bulldl : � ,ci s�Jt�. St��r�s' Contract Prlae of Work:$ a�� <br /> Pro osed Use of BuilaEin : ,qn��'. Heaf Source: C]Oas ❑EfaaEric Bdther �.�'+ <br /> eu�idin T e: ❑SFR-betached L1SFR-Attached l�bu lex C1Multl-�aml �#of UnEts: C7Commercla) Cllndustrlal <br /> a af ProJect: I�New ClAddltfon ClRemodel C]Re alr I�T.I. ❑Sf n C7S rinkler C7Demo{Itlnn }�Chan e of Use <br /> AESCRIPTfON OF WORK: <br /> ASSOCIA7ED BUfLDOVG PERMIT# If a Ilaabls: <br /> MBCH�IN�CpL RERMIT AP�'LICA710 PLUMBrWC�P�RM�T APPLI�ATEON <br /> Type of ProJect: �New_ Addn ,�Ilferatfon �pafr Typa of Prnject: ,_,New ddn Iter�tlon ___,Repatr <br /> #af �,fst of Flxtures �°� Uat of Ftxtur�s �°{ L.Ist of Fixfrrrea �pf Llst of Flxtures <br /> Plxtures • Flxt s Flxiares Flxtures <br /> A!C--AEr Nanctlln Units Heat Pum Z Tallet Back(!ow Preventsr Inslde 6!d <br /> �orcad Alr 5ystems UnEt Heater Bathtub Urhtal <br /> Cas PI Ing BoNer t,avatory{Wash Basin Drinkln Fountaln <br /> Water Fiaater Refrl eratlon Shower � �laor Dralrt <br /> 4as FEre lace Wood Stovs Kftch�n SEnk�Rls oaal Grease Tra <br /> Gas Ran Aucting Dlshrvasher Roof Dralns <br /> Cfothes D er Hooku s Other. Clothes Washer Medical C3as <br /> Ran a ond Water tieater Other; <br /> �x st F'an Sink Service Mo /etc. Other <br /> PRINKL.�R/SUpPRESSION SXSTEiVI ' j <br /> ChemicaE or Water No.of Heads ; <br /> ACKNOWLEDOEMEtJ7:I have revfewed fhls app!!calton end conflrm fha Mfamatlon contalnad hareln Is true end oarrect.Work done pursuant fa(hts parmlt musf comply wlfh � <br /> current federel,s�ale,and local law.7he granlfng of a permlf orrfy authalzes approved work and no devlallons therelrom.AevlaHone must IhsE be authorlxed!n WrNlnq from the 1 <br /> BuNding OfticlaJ before being aufhodxed under any clrcumstance.l am lhe ownar,or 1 am authodzed by fhe owaer of fhls property to perlorm fhe wwk for�vhkh app!!ca(fon!s made, � <br /> end I comply wlfh the Stafe Conf�clors Lew 18.27RCWand 28&2QOAWAC <br /> CflyofEVeraR O/pala!use Only ; <br /> ��r� � <br /> � �-�� F�,� ��:�:�...1� . - �1 <br /> Own Authorize AgenE3(gnature q�te (Rev 9/2 018} � <br /> � <br /> � <br />