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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-6810 — FAX 425-257-8857 — w�vw•evereriwa.org <br />APPLICAT10N3 ARE ACCEPTED FROM E AM TO 4 PM <br />•nnoccc. . PROPERlYTA%� PERMIT�n ^ ' <br />tor new wnsN,,aion: snon <br />t Oh ll d neol F�e <br />& I Lic. <br />g/�/3 <br />Nli PERMIT APPLICATION <br />Fxisting Use ot Building <br />Pr000sed Use Of Buildir <br />(attach <br />� <br />u 1j (r��stl�Se.. <br />PRICE OF WORK <br />�y type; Single Family _ Duplez _Townhouse _ Multi-Family _ Commercial <br />of proje�t: _ New _ Addition _ Remodel �epair �T.1. _ Sign _Sprinklei _,Demolition_Change ot Use <br />iDlion of Work (adddional space pmvitletl on tM1e Dack): <br />you sWrted working without a pertnitl _YES (/NO <br />APPLICATION <br />ofProject: _New_AdCn _Altaratlon_Repalr <br />Number of Heads <br />PLUMBING PERMIT <br />ProJect _Naw_Addn _Altentlon <br />Mediwl Gas <br />Other. <br />Other. <br />I hareby certiy that I have read antl ezaminetl this apd��Gon and know the same to Ee hue and correcl All provisions of laws end adinances Bovemirp <br />this rype ol wvrk will bc wmplied with whether spedfied herein or no4 The grandnB of a pertnit dces not presume to 9ive autlionly to violale M cancal <br />the provision of any other state or local law repulating conshuction w the perfortnance ot consWGion. That I am aNhorizetl Dy the o�*�er of this properry <br />to perform lhe work fa which applicalion is made and I comply wi Ne Stale Contredors Lew 1817 P.0 W and 296.200 WAC <br />;� �� � �I <br />OwrrerlAutho d Agent Signatuir Date (RevisedY1071) <br />