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Ow ner n�'►"� � <br />PERMIT APPLICATION � �'�SQ�I <br />[3UILDING/MECHANICAUPLUMBING/SIGNISPRINKLER/DEMOLITION <br />CITY OF EVEF2ETT PERMIT SERVICES <br />3200 Cede' St., Everett, WA 98201 • 425-257-8P10— FAX 425 257-8857 —www.everetlwa.orgG //�� �5 <br />APPLICATIONS ARE ACCEP rED FROM 8 AM TO 4 PM <br />I,xner��constructwr Sh�rt <br />BELMONTE <br />d <br />)7 <br />PERMIT APPLICATION <br />81Uc <br />No <br />PRICE OF WbRK <br />ol bng Ic�9a� AeunO�p�� <br />Exla�ing Use of Building ti�" � — <br />Proposed Use of Buildmg SAMF Gas Electnc otner <br />Bui!jing type: Single Family _ Duplex _Townhouse _ Mul6-Family _ Commeraal <br />Type o1 projed� _ New _ Adddion _ Remodel _ Repav _ T.I. _ Sgn _Sprmkler _DemoliUon_Change of Use <br />Descriptlon of W�rk (anananal sn�� P��"� o^ the Dace1 �. <br />SAME <br />slaAed working without a permit7 _YES _NO <br />PERMIT <br />ol Profect: _New _Addn _A��ertlion _Repelr <br />PfEIC� <br />�ater <br />PLUMBING PERMIT <br />al ProJecl: _New _Adtln __Mlleollon _Re'dl� <br />heater <br />MediwlGas <br />Other <br />Other <br />I nereby cendy t�at I have rnaa nM eaammeE INs aoWicabon end krww the same to Oe Irue and cared All provisans ol laws arM oNinances govemmg <br />�his type ol vurk vnll De com0��� �tn whether speu6etl herein a nol TOe granting ol a pertnit �oee not presume l0 9��a authonry to vio�ale w cancel <br />the pmvis�on ol any olher slate or locai law regulabng construcLon or t�e prtrtom�a�+ce a� constructro� Thal I am authonzed �y Ihe owner ot I��s pmpe�Y <br />lu perlOrm Ihe woik lor whr.h apDbcation is ma0e enU I compy++th Ihe Slate Con:ractaa Law 1 B 27 RCW en0 49B 200 WAC <br />��3� Il <br />wnorlquthotlzed Agenl SlgnaWre <br />T� Date fRense07/IOU� <br />