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PERiIl11i AF'PLICAiIOiV <br />BUILDI�ECHf�NICAL / F'LUNiBING / SIGRI �RINE�CLER / DENtOLITI�N <br />CITY OF EVERETT PERMIT SERVIC <br />� 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-Z57-8810 � FAX 425-257-Sf357 �(E) everetteps@everetbva.gov � www.everettwa.gov/permits <br />: , <br />..::: ; , <br />_ ..:_ . . <br />PROJ�GT SITE IidIFOIZMA7'I;ON , <br />�JECT SITE ADDRESS G�u �� �c PROPERTY TAX #: <br />��a <br />�AL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />,_.,.. ,.:: <br />-' RI Irl nlNt`:' PFRMIT OPPLICATION...:` _`- ' ' <br />Existing Use of Buiiding: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached ❑SFR-Attached L D� <br />Type of Project: ❑New C7Addition ❑Remodel C7Rep� <br />DESCRIPTION OF WORK: <br />� ,� �} I ��� � �..� �'� �— <br />IASSOCIATED BUILDING PERMIT # (if applica <br />Contract Price of Work: <br />Heat Source: I�BGas <br />;x OMulti-Family-# of Units:_ <br />C]T.I. L7Sign OSprinkler <br />I-� t���Pa� <br />❑Electric ❑Other <br />ClCommercial ❑Industrial <br />ClDemolition ❑Change of Use <br />ACKNOWLEDGEMENT.� 1 have reviewed this application and confirm the information contained herein is true and correct Work done pursuant to this permit must compJy wifh <br />current federal, state, and local law. The granting of a permit only authorizes approved Work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Offrcial before being authorized under any circumstance. I am fhe owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and l comp/y with the State Contractors Law 98.27 RCW and 296.200A WAC. <br />Cify of Everett O�cial Use Only <br />� �� �.�� PERMIT # �� y� <br />� /�� � % � lG'� l ' i/� � <br />� ���Ls/ „ �/ . <br />"„r,�r/authorized Aaent iqnature Date (Revised 10/12/2015) <br />