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� PERMIT APPLICATION <br />BUILDINClJIECHANICAL / PLUMBING / SIGN / �INKLER / 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/permits <br />PROJECT SITE INFORMATION <br />�E�C� T�) E��D� ��,� ��� PROPERTY TAX #: � 9d r^-.3 � 66 �� r QQ6 <br />J <br />3AL for new construction: Short PlaUsubdivision_ __ Lot No. (attach copy of long legal description) <br />BUILDING PERMIT APPLIGATION <br />Existing Use of Building: ( � Contract Price of Work: $ S O� � d <br />Proposed Use of Building: S I j� F tisGf� Heat Source: �Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached �FR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel �Repair ❑T.I. ❑Sign OSprinkler �Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />12�PA-( ►'L v� A�-�u��-� `� t�►�. �'o �G'n� � 5�,�► K� o ��s <br />�ASSOCIATED BUILDING PERMIT # (if applicable): <br />ACKNOWLEDGEMENT. 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must compry wrtn <br />current federal, state, and /ocal 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 0/ficial before being authorized under any circumstance. I am the owner, or I am autho�ized by the owner of 1/�is property to per(orm the work (or which application is made, <br />and I comp/v with the State Contractois Law 18.27 RCW and 296.200A WAC. <br />City of Everett Officia/ Use Only <br />PERMIT # <br />���Z��/ ����� .�C��� <br />�O <br />rized Agent Signat � e Date (Revised 10/12/2015) <br />�l� <br />