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� � <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRIMKLER / DEMOLITION <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/permiYs <br />PROJEGT SITE INFORMATION <br />�JECT SITE ADDRESS: PROPERTY TAX #: <br />1231 Rucker Ave Everett. VVA 98201 <br />for new construction: Short Plat/subdivision Lot No._ (attach cx�y of iong legal description) <br />1 BUILDING PERMIT APPLICATION <br />Existing Use of Buiiding: <br />Proposed Use B ilding: <br />Building Type: SFR-Detached ❑ FR-Attached <br />T pe of Project: ❑New ❑Addition Remodel <br />DESCRIPTION OF WORK: \ <br />�CJ� �` l�v6,���7 r <br />ASSOCIATED BUILDING PERMIT # (if ao�licablel: <br />Contract Price of Work: 9 <br />Heat Source: ❑Gas <br />❑Duplex ❑Multi-Family-#ofUnits: <br />IRe air ❑T.i. ❑Sign ❑S rinkler <br />i� Sy.SfC',i^� (�r'`/ -i�-E <br />�l <br />❑Electric ❑Other <br />❑Commercial ❑industrial <br />❑Demolition ❑Change of Use <br />. 3� r�.. �pl,; jF 5. <br />ACKNOWLEDGEMENT: ! have reviewed this application and confirm the information contained herern is true and crorrect. Work done pursuant to this permit must comply with <br />current federal, state, and /oca!law. The granfing of a permit only authorizes approved work and no deviations there(rom. Deviations must first be authorrzed in writing from the <br />8uilding Officral before being authorized under any circumstance. 1 am the owner, or ! am authonzed by the owner of this property to perfonn [he work for which application rs made, <br />and I comply wifh fhe State Contractors Law 18.27 RCW and 296.200A W.4C. <br />Crty of Evereft Officia! Use Only <br />�(' PERMIT # <br />O��/f r�uthonze�ent 8`�_ ��� r� ' � �' ! � _ � `�� W a 1 / �� <br />��9 � 9�atbre Date (Rev�sed 10/12/ZOi5) <br />