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F'ERMiT' APPLIC,�TIOiV <br />BlJ1LDIN,�flECHANICAL ! PLl1MB1iVG / SIGN �I�INKL�R ( DEf�IO�IT'ION <br />CITY OF EVERETT PCRMIT SERVICE <br />� 3200 CEDAR STREET, EV�R�TT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov j www.everettwa.gov/permits <br />. _ ,._ <br />- <br />�: : <br />;: : �, �:.�. :,.'., . . :PRO.]EC7' SITE INFORM�►TIOAI `. ; <br />....:..:..: ::..�:_..,.... ...: .. _.:_. :.:: ... _ .. . <br />�J CT S 7E ADD SS: PROPERTY TAX #: <br />��t--V �� Fit,�2� i <br />�AL for new construction: Short Plat/subdivision Lot No. (atfach copy of long legal descriptian) <br />Existing Use of Building: 1^� �� `� �`� d r <br />Proposed Use of Building: 7f�'�'�"Z--' <br />Building Type: ❑SFR-Qetached ❑SFR-Attached <br />Type of Project: C7New I�Addition ❑Remodel <br />DESCRIPTION OF WORK: �� P��,}�� <br />TED BUILDING PERMIT # <br />.� ,,, Contract Price of Work: $ <br />Heat Source: ❑Gas ❑Electric �C <br />❑Duplex ❑Multi-Family� of Units: C1Comrr <br />C7Repair I�T.L I7Sign �Sprinkler ClDemoiition ❑ <br />C� �9 S /tl -' ,T" �/ Tf�N I.�-c-- �—SS <br />❑Industrial <br />of Use <br />ACKNOWLEDGEMENT.� 1 have reviewed this application and confirm the information contained herein is true and correci. Work done pursuant to this permit must comp�y w�tn <br />current federal, state, and loca! law. The granfing of a permit only authorizes approved work and no deviations therefrom. Oeviations must first be authorized in writing from the <br />Buildrng Offrcial before being authorized under any ci�cumstance. 1 am the owner, or! am authorized by fhe owner of this property to petform ihe v✓ork for which application is made, <br />and ! corr�AACwith the State Contracfors Law 98.27 RCW and 296.20DA WAC. Cit of Everetf O�cia! Use Only <br />��� <br />rized Agent Signature <br />Y <br />PERMI7 # <br />1 c� l ��'� —DD� <br />Date (Revised 10/12/2D95) <br />