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NPaI �w n �' �" <br />PERMIT APPLICATION <br />BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLERIDEMOLITION <br />CITY OF [VERETT PERMIT SERVICES <br />3200 i:edar SL, Everett, WA 98201 - 425-257-8910 - FAX 425-257-8857 - www.everetlwa.o� ^p 7 <br />APPLICATIONS AFE ACCEP'; EI� FROM 8 AM TO 4 PM =��L�O �� / <br />"__"_ PRi�PIplyTlUf■ PERMITN��.7^7 � r) <br />_�GAL fo ner. conslruc'bon Snoh PlausubAinsan_ <br />Dwr+ea (tOBERT PERA550 <br />4daress 4405 103RD 11VE SE <br />�.�-- <br />CONTRA�'TOR ROB'S ELECTA�r �NC <br />naamss 4405 103RD AVE SE LAK[ � <br />TENANT 3USINESS NAME <br />BELMONTE <br />BUILDING PERMIT APPLICATION <br />Exislmg Use ol Bwldmg tQ <br />CHE D Lat P4 �_ IatlaU copy ol bng IcgalOewiplion) <br />PMnel6maA 425-334-6834 <br />cnYistate2�P WKE STEVENS, WA 98258 <br />L81LkN • <br />WA 98258 Pnonei[maii 425-334-6834 <br />CONTACT I�OR PERMIT <br />Phone/Finad <br />CONTRAC7 PRICE OF WORK <br />HEATSOURCE�. <br />roposed Use ol8utlding SAMF I �as r.�n:����_ .. _ <br />aildmg rype. _ Single Family _ Duplez _Townhouse _ Multi-Family _ Commeicial <br />�pe of project __ New _ AtldAion _ Remodel _ Repatr _ T I. _ Sign _Spnnkler _Demoldion_Change of Use <br />escnplion ol Nbrk (atlmlronal spacn provHleO on flre Dacq �. <br />SAME <br />you started working withoul a pe�mlt7 _YES _NO <br />PERMIT <br />ol Projecl: _New _lltltln _Alteretlon _Repalr <br />Gas <br />Pro�ecF. _Naw _Atldn _Altentlon _Rep�lr <br />5hnw NumDeilNl ol flrturcs <br />Wmal <br />drmn <br />Med�wl Gas <br />Othec <br />I he�e�y cetldy I�al I have rea0 ana eaamined Ihis aDDbcation antl hnow lhe same �o De Irue and correci All Dmvisions ol laws and o�dinances Bo�emmg <br />In�s lyp' ol Mork vnll be tompbea �MI� Wttet�er spe[dietl herein or nol The grantug ol a pEfmit tices nol Presume to B��e aut�only lo vldatP, a Cance1 <br />me pmvismn ol any olner stale or iocal law reyulaUng m��stnicbon or Ine perlamance ol constmclan Tnat I am authoraed Dy Ihe awner ol ihrs propeny <br />Io oedorm Ine v.oiM 1or wtuch apPlication is made anU I comply wiih Ine Stale Conlractas Law 1B Y7 RCW erW 298 200 WAC <br />^ `�� � =— � (Rov�seC1/2011) <br />nerlRut�arlxaOAgenl5lgnature ��/// Dale <br />