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� � <br />PERMIT APPLICATIOM <br />BUILDlNGIMECFlANICAL/PLLMB:NG/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.evere a.or]q <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /S /�� <br />ADD ESS: PROPER7YTA%q PERMITN D—�p <br />G,� �.Q Fvv_r 4�'Ce�� �t/A'; ' <br />EGAL lor new wnstrudian: Shor1 PlaUsubtlivision Lol No._ (atteUi copy ol <br />iNMER �/ I 6 /-'GiM�/ � 1�0� PtwnelEmail 7� '�� <br />aaress �/�!/' Y eh (,(/,� CirylState/Zip E IJCI^e <br />��ONTRACTOR � �q � l� - l r 1 C� L 8 I Lic. # �l Ait <br />� 7 � ��0 I'ff `-7 /v LC� S �C�-r��� ` �mail <br />ddress 7 .J / <br />ENANT BUSINESS NAME < F�M CONTACT FOR PERMR � <br />//1p � V <br />MD ���� l/(i1%i'� �� (,t4�Q/VILQ �'%�� hone/E-mail %j'�6N�e+ �C <br />3UILDING PERMIT APPLICATION CONTRACT PRICEOF WORK= <br />legal descnplion) <br />�''/i <br />W� <br />o � K9 <br />2 in <br />t . �I.6Yrh� <br />Existing Usc of 6uilding /a C�G' w 1 vTT[ � c <br />ProposedUseofBuilding ��MeY0.f aF��;c� �as� Eiectric_ o�her_ <br />Buildingtype: _SingleFamily _Duolex_Townhouse _Mulli-Family �Commercial <br />Type of projecl: _ New _ Addition _ Remodel _ Repair_ T.I. _ Sign�Sprinkler _Demolilion_Change of Use <br />Description of Work (additional space pmvided on the back) : L <br />D�t��laot� Si g j� Moc,.�-Fe� cs n b u; lcl � r� �ri�.ca.or e-' y�. �� � <br />Have you started working without a pertnil7 _YES �NO ( G�� ��5 H�'� �� <br />IT APPLICATION <br />ProJecl: _New_Addn _Alteratlon_Repair <br />SUPPRE3310N <br />ofProjecl: _New_Addn _Alleration_Repalr <br />Medical Gas <br />Other: <br />,� <br />I hereby certity lhal I have read antl examined this applic�tion antl know lhe same to be true entl cortect. All piovisions ot laws aM ortlinances goveming <br />this type of norY. vri�l be complied v.ilh whether specifed herein or noL 70e granling ol a pertnit dces not presume to give authority to violate or pncel <br />the prwision of any other stale or loral law re9u!eting construclion or :he perfortnance ol consWGion. That I em aidhorized Dy Ne owner of lhis pmperty <br />lo pcAorm lhe Hark for v.fiich application is mad�mply with Ih�� t�% � do%/�-�' �8.27 RCW and 298100 WAC <br />_y /���;.ilo - .7 <br />OwnurlAuUioAzedA nalure Dale (Revised220f7) <br />