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PERfli11T Ai'F'LICs4TI0iV <br />�UILDIfV�ECHANICA+L / F'L.U�IBIYVG / SIGN �121NC�CLER / DEMOL.ITIO1� <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-881D � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />; <br />' ..:.PRO�ECY SITE iTIFORiViA'TIOPJ ` <br />CT SITE ADDRESS: rrcvr�r� i r i Hn rr: <br />,��� �.� � , ��,;., �;� �� ,;� <br />fo� new construction: Short Plabsubdivision Lof No. (attach copy of long legal description) <br />xisting Use of Buiiding: <br />roposed Use of Building: <br />uilding Type: ❑SFR-Detached ❑SFR-Attached <br />ype of Project: I❑New C�Addition ❑Remodef <br />ESCRIPTION OF WORK: <br />N PN� � �, � .�� <br />IASSOCIATED BUILDING PERMIT # (if a <br />Contract Price of Work: <br />Heat Source: ❑Gas <br />❑Dupiex ❑Multi-Family-# of Units:_ <br />ClRepair CIT.I. D�Sign OSprinkler <br />Cl� 1 �� � ln: � c_.��� �j l;�r.ctS <br />C� <br />❑Electric ❑Other <br />C1Commercial ❑Industrial <br />ClDemolition ❑Change of Use <br />Q 1'� �V`J r (1 i� �j <br />RCKNOWLEDGEMENT.� 1 have reviewed this application and confirm the information contained herein is true and correct Work done pursuant to this permit must comply with <br />current federal, state, and local /aw. The granting of a permit only authorizes approved work and no deviafions therefrom. Deviafions must firsf be authorrzed in writing from the <br />Building Officia! before 6eing authorized under any circumsfance. I am the owner, or i am aufhorized by the owne� of ti�is properry to perform the work for which application rs made, <br />and I comp/Y with the Sfate Confractors Law 18.27 RCW and 296.200A WAC. <br />r� <br />Agent Signature <br />��1���r�, <br />uate <br />Cify of Everett Off�cial Use Only <br />PERMIT # �� ��� , ( _ �-���� <br />`-r <br />(Revised 10/i2/2015) <br />{ /� <br />'-� <br />