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��r�t�i� �,�P�.ic,����� <br />�ui�r�i�v� � nn�c�,���c,�� ���.u�ai�G i sr�� � i s���n�K��� i�����.iri�� <br />C17Y OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@evereftwa.gov � www.everettwa.gov/permits <br />; _ . ;. �ROJECT SITIE IIdFOi2MAT10N: _ : ,-. <br />: _ _. <br />PROJECT S1TE ADDRESS: 73 � 3 !`"C'�P�� � V�� PROPERTY TAX #: OD �3 7�5�� BSOD60D <br />J <br />LEGAL for new construction: 5hori Plaf/subdivision Lot No. (affach copy of long legal description) <br />- <br />` ` BUILDING PERMIT APPLICATION <br />Use of Build <br />Proposed Use of Building: <br />Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑ <br />Type of Project: ❑New ❑Addition ❑Remodel ❑RE <br />DESCRIPTION OF WORK: <br />Contract Price of Work: $ <br />Heat Source: ❑Gas ❑Electric ❑Other <br />lex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />� ❑T.I. ❑Siqn ❑Sprinkler ❑Demolition ❑Change of Use <br />�ASSOCIATED BUILDING PERMIT # (if applicable)_ � <br />ACKNOINLEDGEMENT: ( have reviewed tliis application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply wifh <br />curreni federal, state, and local law. The granting of a permit only authorizes approved work and no deviations theref�om. Deviations must first be authonzed in writing from the <br />Building Official befa'e being authonzed under any circumsfance. 1 am fhe owner, or / am aufhonzed by tlie owner of this property fo peiform the work for which application is made, <br />and / comply wifh fhe State Contractors Law 98.27 RCW and 296.200A WAC. <br />"lU O I <br />Owner/Autfiorized Agent Signature Date <br />C�fy of Everetf Offiaa se n y <br />PERMIT �f � <br />(Revised 90/92/2095) <br />