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PERMIT ��PPLICATION <br />BUILDING/MECHANICAL/PLUME3;NG/SIGNISPRINKLER/DEMOLIiION <br />CITY OF EVERETT P: RMIT SERVICES �� �p?--D(%l <br />3200 Cedar St., Everett, WA 98201 - 425-257-£3810 - FfV( 425-257-8857 —wriw.everatiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6.4M T04 PM %.- 2� 3 <br />SITEADDRESS: � �, PROPERTYTA%p PEFhtITk <br />`y/�1 ��v�ts' LAw�e_ CJON7/�C7G:�n�S�x� vi an7_ nn <br />fornewwnstruction: Short <br />BUILDING PERMIT APPLICATION <br />Use of BuilJing <br />_Lot No.__ (::tta h ccpy ot long legal description) <br />Phoner.m�u yZ-`� 'a'.�'2 —.3�f%� <br />City/5tstenip �(/�J2� ��'� GL�t�- '� J ci�`� <br />l 8 I Lia r ' 1 � � �,' <br />'/f_ i�5(.� j � Phonc/cm�i� � Z �J � / 7 �-Yj V! �4 <br />CONiACT FOR PERMIT -, p� � � <br />��'��'� I�/i7JC'L Ir= <br />Pno^�e/Em�: �ZJ"_.7%,�y�.C/��� <br />CONiRF,CTPRICEOFWOR _�l,O/L�.�%� <br />Proposed Use of Building � Gas__ Electrio O:r,er <br />6�,ii!dina type: ,�_Singie Famity _ Duplex_Tovmhouse _ �Aulti-Femily _ Comm=rcic! <br />T�pco(pmjeck _Nevr _Addition _Remodel _Rep2L^T.I._Sigr_Sprinkler_Demolition_Change o`U:F <br />D_=_criptionoflh�ork(cdd;Uc�aa�epaceprovldedonfhebzc&): �'���,j(C CV�}'�2- .SL�'N�G� y"�-eJ��-j'}�_ <br />�}}Crtit.L_. �=r'LCv�1 '7�}-�'t� f{O�t�.� 'j-tj 'T1-��. Cl ��-i° <br />� �� <br />Heve you start=d tvad:in� tvithout a permit7 _YES ,�itJO <br />MECHANICA! PCRMIT APPLICATIOq <br />Typc of ProJccC _Nc�i_Addn _Altcmtion_Rcpolr <br />Gas <br />of Hezds <br />SYSTEM <br />PLU67BRJG PERI`dIT APPLICATION <br />TypeolProjcct _Nav_Fddn �(AlleraUon_Ropair <br />Shovrer <br />Medical Gas <br />Other. /, )d <br />I Y�ereby certiy lhat I have rezd end exzmined Nis epplic;tion ord know the s2me lo be We snd correct NI provisions ct laws 6nd ordinances 6ovemirg <br />RJs l�pe olrark vdll be compiied Hith wheNer spedfcd herein or not The 9ren6ng of e pertnit Coes nol presume to pive euthoriry to vloiate or cancet <br />lne provision of eny olher etzte or local la:v regulatlnp wnsWdion w the pedormance of wnSWcticn. That I em euthoriz�W by the wmer of Ihis property <br />U FE `y� Ne uor'R lor v' eppiiw o�2de end I comply wlih ihe State Contractors Lew 78.27 RCW and 295200 N'AC <br />�. -� ,��; , <br />OvmedAVlhorizedApentSlg u Date (Revfsed7r2011) <br />