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• PERMIT APPLICATIO� <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-88� 0 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: � ''_ �.� Contract Price of Work: $ �� 1�:� .�j - <br />Proposed Use of Building: �� ,�� Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: Commercial ❑Industriai <br />Type of Project: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�U�31��EA T�1�-L�-- �a�._ �Pae-� i�o a�� ��t�_ `�. <br />/'�" '! 7, � � ��' . ' , '1: i' �s= ?—; � �- <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />ACKNOWLEDGEMENT: I have r' e�t7this application and confirm the information contained herein is true and correct. Work done pursuant to this permif must comply with <br />current federal, state, and lo aw. e granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building ONicial before g au rized under any circumstance. 1 am the owner, or I am aufhorized by the owner of this property to perform the work for which application is made, <br />and I comply with th tate ntractors Law 18.27 RCW and 296.200A WAC. <br />� City of Everetf Official Use Only <br />� PERMIT # ` <br />.-� -- �/- Z� � i�, � �� �" � � � <br />Owner/Authorized Agent Signature Date (Revised 10/12/2015) ` <br />6f �� <br />I <br />