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�_ �.-� <br />� <br />v���� <br />Qr Black ink <br />� PERMIT APFLICATION� <br />BUIE.DiNG I MECHANlCAL J PLUM81hIG 1 SIGN i SPRtNKLER ! DEMOLITION <br />CITY OF EVERETT PERhrtIT SERVlCES <br />3200 GEDAR STREET: EVERETT, WA 9$201 <br />tP} 425-267-889 Q( FAX 425-257-$$57 �{E} everetteps@evere#twa.gov � wtaw.everethva.govfperrnits <br />i e e+r�.� � �� <br />�lease} PROJECT SlTE t�Ai�t'�R�llt�tTIC1N <br />SITE ADDRESS: (,�r ,�.11 <br />'i� <br />Pao�e��r�r r,4x #; �,�,.3scnoo�roY�O <br />€or new constructiQn: Shart PIaV'subdivis9an LaC �30. (attach copy of long lega[ desenpt�ors) <br />( Siit�.DING PERIVIIT �PP'LICA"!'101� __ _� <br />� Use of Building: <br />�sed tlse of Bufiding� <br />ng Type: ❑SFR•Detached ❑SFR-Attached ❑ <br />of Projecf: flNew ❑Addition ❑Remodel ❑R� <br />;RtP710N OF WORK: <br />3CIATED BUILDING PERMiT # (if aoolicablei; <br />Cortiraet Price af Wark; <br />Heat 5ource: �Gas <br />IulEi-�amiiv-# of Units: <br />�!� <br />�Commereia! Liindustrial <br />QDemolition �Chanpe of Use <br />kCKN04YLEQ�EMENL ! heve reviewed this appt�catr`oa and conflrr�t ihe infomteffon corrtarhed iaerein is t�ua and correct. Work do�rs pursuant to th€s permid must campty with <br />current t`ederai, state, and tacat taw, The granting of a permlt anPy auihor(zes aFproved work and na devfaftons thersfrom. DeviatJorrs must rirsi be autharfzed in wrr?ing from ti�e <br />Bu+tding OiftGlat before being aufhoriled under any cir�Lmsfance. ! em the awner, or / am authorixed by fhe owner o1 this praperty to per(orm the work for whfch appl�catJon is made, <br />and 1 cc+mAly with the Stete Garttractors taw P8.27 RCW end 296.200A 4NAe. <br />��,..-�� . �s.-`---- (o /iY/Zo �(o <br />Owner AuYhorized Agent Slgnature Date <br />Gty of Everett Ufficral tlse Oniy <br />PERMIT # • <br />� �� � ���� <br />(Revised 5/20/2Di6} <br />