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PERMIT APPLICATIOIP <br />BUILDIN MECHANICAL / PLUMBING / SIGN SPRINKLER / DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />W AS H I N GTO N (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: /�� �� IA / CA.S%A rn A1.4 ,J f ;.Y') rgsr-7"?APROPERTY TAX #: I <br />ILEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) I <br />BUILDING INFORMATION <br />ExistingUse of Building: 9: Contract Price of Work: $ ® • <br />Proposed Use of Building: Heat Source: ❑Gas OElectric 00ther <br />BUILDING USE: OSFR ❑Townhouse ❑Duplex EIADU Multi -Family - # Units: ZL ❑Commercial OAccessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair 0T.L ElSign LISprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: gnoov-C- �jJ�� �LICIF-/� L C014( r' <br />ASSOCIATED BUILDING PERMIT # (if applicable): MAL 02 ��j��� ; 1�4K T &?, <br />ACKNOWLEDGEMENT: i have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERhjP# <br />(Revised 1011012018) V V2— <br />