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PERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 -www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: p PROPERTY TA% p PERMIT <br />4-�i U�� % U%�CJ� �/1 � � CJ <br />fot naH construcqon: ShoM1 Plavsuoarviswn <br />t f-(or, FIi,,, �. �7Lto �i <br />Zi`�ili 13�" p� 7JT <br />ACTOR Ok RecF1�G <br />� 1 N g3n•� PL N� <br />T BUSINESS NAME <br />I�i, f �. �F <br />(� 1, � 1 <br />DI G PERMIT APPLICATION <br />Use of Building <br />lol No._ (atlach copy ollong l:gal <br />�� Phonel6mail 1 i I I � � .1 <br />� .t <br />City�SlatGZif L ��r L�-. n � <br />L&ILic.# <br />�ysy�� Phone/Email <br />CONTACT FOR PERMIT <br />PhonGE�mail <br />CONTRACT PRICE OF WORK <br />j. C E7.� <br />Z� � <br />�roposed Use of Building ' -�- -- — <br />3uildingtype: _SingleFamily _Duplex_Townhouse _Multi-Family '✓ Commercial . <br />fypeofprojecl New _Addition _Remodel _Repair_T.I._Sign_Sprinkler,_�emolilion_Change of � �� <br />a w � 1A157i4�L .�5✓�Fo�9*� 545-r6�a Y8 StoP2 I`Y <br />)eSRiption �' WO�k (addilional s ace ovid on fhe backJ :,' � � S� �„�LL <br />1'+v71� S' UQAsx/s (scrr^i+t�:t T+�:�-+v .T,vsrN�t (oo,.�.0 -ri"o BY � ERSZ � tS7i4n+ <br />%S�' l"1CUf/�Nj'CALLS' 1'�sYL'iVlO �.�17N I/°��'Ti7�f �9N✓ SC�PaFJJs <br />iaveyoustartedworkingwithoutapermit? _YES '✓ NO <br />PERMIT APPLICATION <br />olProjech _New_Adtln ,_AllcraUon_Repalr <br />F�i <br />unils <br />ION <br />PLUMBING PERMIT APP <br />7ypootFujecl: _New_Addn _Altemtion_Repalr <br />Medical Gas <br />O�her: <br />� NumberofHeads � """'. <br />I hereby cetlily tha� I have reaa and examinetl ihis applicalion antl know Ih=_ same m be true and rorrxt. All pmoisions ol laws anA sdinances goveming <br />ihis ryFe ol �wrk will be comp�ied xi�h whelher spenfetl herein or noL The g2ndng ol a permA does not presume to B��e authonly to violate or wncel <br />�he pmvision of any other state or local law regNa�ing censimctlon or the pertormanco ol consimction. That I em suthonzeE by the rnmer ol lhis property <br />to pertorm Iha xro�k for which application is mado and I wmply vn�h tha Stale Conlractors Law 1827 RC1N and 298200 WAC <br />i\ � <br />�� �� � 17 U i� �) � �/ <br />OwnerlAWhoiized Agent Signalura Date (Revlsed 7l1017) <br />