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C�nRhqe �-� <br />Uwri P� <br />PERMIT APPLICATION <br />BUILDING/MECH�ANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 902U1 - 425-?57-8810 - FAY. 425-257-8857 - www.everettwa.org <br />x APPLICATIUNS ARE :�C:EPTED FROM 8 AM T04 PM <br />PROP ENTY Tl1% N PERMIT N <br />fEADDRESS: _________..,.,. /� n�7n� _ /1 <br />lornewco�strucbw� Shoh <br />CLI�I.7 <br />ATTACH �c D__ _l.oi No __ la�cau, covr a bng iegai aescnv�aN <br />LAKE STEVENS, WA 9825E <br />BELMONTL <br />BUILDING PERM17 APPLICATION <br />Use ol8wld�ng <br />PRICE OF WORK <br />T SOURCE <br />�sed Use of Bwldmg SA�_ � c;as eiecmc ��r�� <br />mg rype� _ Single Family _ Duplex _Townhouse _ Mu�h-Family _ Commercial <br />of pro�eU�. _ New _ Addtlion _ Remodel _ Repair _ T I. _ Sign _Sprinkler _Demolilion_Change ol Use <br />npGon of Work (ntldrtanal s�urn pmnOcd on tlro Dacq � <br />SAME <br />you started working wlthout a pormit7 _YES _NO <br />_New _Rtltln _Alteretion _Repalr <br />—avi <br />:ed au <br />UnA h <br />lioiler <br />PERMIT <br />oi Pro�at: _New _Atltln _Altanllon __Repalr <br />SMw Number (t) ol flrtures _ <br />Shower <br />Kitchen <br />heater <br />Medical Gas <br />Other <br />I Number of Heads I I tnner. <br />I here�y cenity Ihat I have reaa and examinM In�s applicatron an0 knrnv Ihe same lo be Irue arb cortecl All prowsans M law� enC admnnces pove�ning <br />Ihis type ol work vnll De mm{N�eA vatn whelher speuliM heiein a noI The granbng ol a permit Oces ro1 presume to B�ve eul�ry lo va'ate or cancel <br />Ihe pmv�sion ol any olher state or local law regula0ng consinxiwn o� Ih0 pedamance ol conslnx7�On T�at I am aulhonied �y Ihe owner ol tM1�s pioperty <br />i� p�Aorm tne v.ork v.h�ch aDP�����n �s made and l comDlY �xt� I�e State Contractors Law iB 27 RCW and YBB 200 WAC <br />,�y,C�� ��3�11 <br />(pWnarlAWhotleed Agont Slgneture Dale (RenseO 7R0/7) <br />