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PERMIT APPLICATION <br />BUILDINGIMECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everetl, WA 98201 - 425-257-8810 — FAX 425 257-8857 —www.evereriwa org <br />APPLiCATI0N5 ARE ACCEPTED FROM 8 AM TO 4 PM <br />4DORESS: VRODERf11TAlfp PERMITp _ <br />mr ne«rnacuw�on snon P�auwoams� ATTACHE D Lat No _.___ (atlanc �apy otlong legai tlesaiplwn) <br />L81�c a <br />AVE SE IAKE STEVENS. WA 98258 <br />BELMONTE <br />BUILDI?l�i PERMIT APPLICATION <br />425d34-6834 <br />PRICE OF WORK <br />ng Use ot Building SAMF HEAT SOURCE�. <br />ised Use ot Buildmg SAME Gas Eiectnc___ Othcr___ <br />ng type: _ Smglo Famiy _ Duplex _Townhouse _ Multi-Fam�ty _ Commerual <br />af pro�ed: _ Naw _ Addilion _ Remodel _ Repair _ T.L _ Sign _Sprinkler _Demolihon_Change of Use <br />iption of Work fatltlrtronal spaca Oma0e0 on Mo GackJ : <br />SAME <br />you staMed working without a pertnk9 _YES _NO <br />PERMIT <br />ol Vm�M: _New _Addn _Altcretlon _Repalr <br />air <br />� Olher <br />SPRINKLER I SUPPRESSION SYSTEM <br />Number ol Hcads <br />PERMIT <br />ProJect: _New _AAdn _Al�eratlon _Repelr <br />Floor dram <br />Grease 12p <br />Rool tlrains <br />Medical Gas <br />otner <br />Olher: <br />1 �ere�y wNfy Ihat I M1we n!a0 x�0 ec�mineA Ihix applRatron and krrow IM! same In �c Vue antl axrcU All prohsions ol laws atN ortlinana!s poveming <br />�n�s Nt� oi worr� wii be cand�Pa wnn wne�ner spear�ea nerem a no� me granlug o1 a pertnn eoos not presumn 10 grve ainnonry io wolate or �nrni <br />Ihe povlvm oI nny other state w bral lawr regu4itirg conslnxhon or Ihe pertamantr ot mnStnxUon iTat I am aulhonma �y Ihe wner ol lnis properrry <br />to perlarm Ihe rak Itu whuii applimlion �s madc arM I mmply wih Ihe Slete Cwilraclors law 1B 17 RCW ariA 79B 200 WAC <br />ner/ANMtlted Agent Slgnature �/' Datc lRon5otl7R011) <br />