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PERMIT APPLICATIOi� <br />BUILDIN IIECHANICAL / PLUMBING / SIGf�I i ai-v�INFCLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, �VERETT, WA 98201 <br />(I') 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />' ` PROJECT SITE INFORMAT.ION : ' `' <br />_ _ <br />ROJECT SITE ADDRESS: ��� , �� PROPERTY TAX #: <br />. _ <br />�LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Iong legal description) � <br />I <br />=xisting Use of Building: <br />'roposed Use of Building: <br />tuilding Type: ❑SFR-Detached ❑SFR-Attached <br />�ype of Project: ❑New ❑Addition ClRemodel <br />lESCRIPTION OF WORK: <br />� � �.�� <br />OCIATED BUILDING PERMIT # (if <br />Contract Price of Work: <br />Heat Source: ❑Gas <br />aplex ❑Multi-Family-# of Units:_ <br />air ❑T.I. ❑Sign ❑Sprinkler <br />� ���5 I � � �. �.� <br />❑Electric OOther <br />OCommercial ❑Industrial <br />❑Demolition ❑Change of Use <br />ACKNOWLEDGEMENT.� I have reviewed tliis application and confirm the information contained herein is true and cor�ect. Worlc done pursuant to this permit must comply with <br />current (ede�al, state, and local law. The granting of a permit only authorizes approved work and no deviations theref�om. Deviatiw�s must first be authorized in w�itrng from the <br />Building Olfrcial before being authorized under any circumstance. 1 am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />a„� i ��rr,.,n� wifh the State Confractors Law 18.27 RCW and 296.200A WAC. <br />Agent Signature <br />City of Everett Official Use Only <br />� 1'� 2 c.' �tX PERMIT # �( ��;1�� V V I --- <br />l V <br />Date (Revised 10/12120i5J <br />� ��5 � <br />� � <br />/� � <br />