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PEFZMIi ,4PPLIC,�T'IO <br />�UILDIi�iVIECF-IANICAL I PLUiiilBlll�G / SIGI F'RIN�CLEF� I DEfV10L.ITlO� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />_ . ,:. , :. . _ :. _ <br />_._ <br />... <br />PROJECT S17`E ➢Id�'ORMATION.; ' <br />_ :;..:. .... _ _ . :. _ - <br />PROJECT 51TE ADDRESS: ,. � PR�PERTY TAX #; <br />3 � � " i-�-� ��,. ��. <br />LEGAL for new construction: Shorf Piaf/subdivision Lot No. (attach copy of long legal description) � <br />_ ... . _ .. <br />; <br />_.,_ : ,. _ . , . _ - <br />' BUILDING PERMIT AP. PLICATION - ` <br />Exisfing Use of Building: <br />Proposed Use of Buiiding: <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duple: <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair <br />DESCRIPTION OF WORK: <br />^ �-: l i j� •. : f.. ,...,.e. ��-c.� U'� l Z-.... <br />.f- rz g <br />, ., <br />TED BUILDING PERMIT # <br />� <br />� <br />� <br />Contract Price of Work: $ <br />Heat Source: ❑Gas ❑Electric ❑Other <br />lulti-Familv-# of Units:_ ❑Commercial <br />❑Demolition ❑Chan� <br />❑Sign ❑Sprinkle <br />r�..J � �"��' <br />❑Industrial <br />of Use <br />ACKNOWLEDGEMENT: l have reviewed this application and confirm fhe information contained herein is true and correct. Work done pursuanf to fhis permit must comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviafions therefrom. Deviations must first be authorized in writing from the <br />Building Official before being auPhorized under any circumstance. 1 am the owner, or I am authorized by the owner of this property to perform the work for which applicatron is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />' U O 1 <br />Cify of Everett Officia! se n y <br />PERMIT # <br />-��,��.�-.� � �- ��__� �;�� �' L l� - aV� <br />Owner/Authorized Agent Signature Date (Revised 90/92/2015) <br />