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0�/06/2017 THU 12e1$ FAX FAst ��Or HOatOr f�006/006 <br /> 8`��8�� <br /> P�RM1T APPLICATION <br /> BUILDING I MECHANIcAI.I P�.UMBtNa !51G�!I SPR�NKZER��EMo�iTroN <br /> l�r.�'j CITY OF GVERETT PERMIT SERV(CL-8 <br /> �� 3200 CEDAR 57'R�CT,�VERETT,W/198201 <br /> (P)425-257-Q970 � FAX 4Z5-257-ti85� �(�)evareltep9�ev�reNwa.gnv� www.evoretlwa.gov/perml[a • <br /> Blue or Bla�k�nk pnl PR�IJLC�SI'1'�'IN�ORIUI/�,YNON <br /> PROJECT SITE ADDRE8 �j ( PROPERTY TI�C i!: � � <br /> . LEOAL 6or new conatrucfio�: Short IAV6Q d{vleion Lot No. �eitach capy vf long legel descrf�tlon) <br /> CON'�.E#C�IN�o�MAT10N <br /> OWNER MAM�: N ( TENANT NAME IP CommorcIa[): <br /> OVVN�R iVIAfLIN�ADDRESS: srneer � ' � (�" <br /> CRIr 97A7E IIP ( <br /> OUVN�I�PHONE: ' � OWNER�MAI�.: <br /> CON7FiACTOR NAM�: S"� '� "(� <br /> CONTRACTOR ADDR�SS; STREET �"�, � <br /> • CI7Y � � 6TAi@ zrP 1 <br /> CONTRqCTOR PHON�; �a`,rj �j CONTRACTbFL EMAlL: �V�'l 1�TS �l.v '}�. <br /> CON`I'I�ACl'OR LICEf�t9E#(FiGQUIR�D): S � �� CITY OF EVER�TT 6U91NEB��,ICENee#(REqUlREO): �j� <br /> PRIMARY CONTACT: ❑OW�}�R CONTFiA�CTOR ❑OTHER(PleasB Sp60ffy) <br /> coNTACT NAM�: CONTAC7 PWON�: �f�j <br /> K�T� �� !�� CONTACT EMAIL: �I-�-S �- .�Q�/', �1/j/� <br /> BUflD1NG PLRMIT APPLICATtON <br /> � Exlstln Use af Bulldin : Contract Frice of Wark:$ � <br /> Pro osed Uee of 6uildin : Heet Sourc�c K7Gas le�trlc ❑Other � <br /> Balfdtn T e: OSFft-Detached �SFR�Atkached ODu lex ultf-F'amfl #ofUnits: I�Gommercl�i Dlndusfrlai <br /> e of Pro ect: ONew DAddition ORemodel iZe air �T.l. �78i n ❑S rinkler ppamolltlolt C1Ch�n e oi Use <br /> DE8CRIPTION 01=WORK: <br /> �irn o�� � re�1��� ���G-I�iG ����r 1�e a� : <br /> A,380CfATEU BUILDINO PERMIT Y� If a llceble r <br /> M�CHANIC�#L p�1�MIT APPl,�C,p'�NON PLUMBIl11G PERMIT APPLIC/I1TlON <br /> 7ypo of ProJeol: �,�Vaw,.� Addn _,_,}1lkaratlon „_Jiopa r Typa of project: _New �ddn ,,,�Allisratlon ,_Rapelr � <br /> '�°r L/st of s �oF tfst ot P ures #of Llat of F/xturee #ol Llat of Fhrturos i <br /> FfxtureS Flxturos FlYfure9 FIxt�YA9 I <br /> AIC Ir Handlln Un Heet m 7oll�t S�CI<flow P�evenber Instde Bld <br /> � F ed Air 9 atem� U i Neater Bathtub Urlreal k <br /> PI In oller Lavato ash Basln Drinkln �ountflln � <br /> pter Heeter Refrl eratfon Shower Floor Araln � <br /> as Flte laCs Wood Stave Kltche�Sink 8�D!s oee�l Greasa Tra � <br /> 088 RHn e Ductlll Dlahwasher Rvof dralne ; <br /> 01he9 D er Hoaku thar' Cloih�s W�sher. Medlcal G�s ' <br /> n e Hood Water He�ter otr,er. � <br /> �x 8 Sink Servlce/B�dMa elc. Olf1�r: ; <br /> SP IN R3S10 1fS'f�M I <br /> emlc��vr w .of Flaads ! <br /> ACKNOWLEpGEMEIV'f.�I have rovlewatl fhls appllce!!mn errd conflrm Nro lnfonnalloR confahied Aer�sA�Is frua and cwrecl.Wo�k doAB pur�uenf la N�Is peim/t mu9t campfy wlfh ' <br /> eum�nt/etlarel,sfete,end lace!�aw.The�renNnq ol a permll only authorlres epproved work antl no Cavlotlons tha,�from.DawaHona musf Ar��Ae authvrlreq/n wrlUna from fho � <br /> BuNd/ng ONIc►s/Dewn beMB$��horixad w�der sny ch�eainalenca.!em(Ne owner,or!am eufho�fzad 6y fhe owner ol fhla propaKy fo pa,ferm!he worh for whlcH epplloeNon!s mode, <br /> errd 1�mply wl�h fhe Stat�Contrecfom LAw 18.27 RCW end 29B 200A WAC <br /> Clly nf Evereff OHlcle!Usa On1y � <br /> � � 'M r � P�RMI1'�'n/� ���� �V ��J I <br /> � �I� � <br /> Own utfior a AB 8lgnafure Date (FZevse Sa�2 0 ) � <br /> 1 <br /> ; <br /> I <br />