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( <br />PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBINGISICNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8870 — FAX 425-257-8857 — <br />APPLICATIOHS ARE ACCEPTED FROM ! AM TO 4 PM <br />for new <br />Short <br />ai <br />PERMIT APPLICATION <br />Use of Building <br />+Y <br />PRICE OF WORK <br />r of lonp leyat desaiption) <br />� 0 <br />tJs4 9�' 2 7.� <br />�zs-.�yy-.�o <br />tN✓J <br />a..OI. GOw� <br />HEAT SOURCE: <br />�sed Use oi Building c..�a ✓a 9� I Gas_ Eleclric_ Olher_ <br />ng type: _ Single Family _ Duplex _Townhouse _ Multi-Fami�y _ Commercial <br />of projed: � New _ Addilion _ Hemodet _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Chenge of Use <br />:criplion of Work (eddif(onal apace provided on fhe back): <br />�oN��k�� �� G..� y� <br />you started working without e permit9 _YES �NO <br />MECMANICAL PERMfT APPLICATION <br />ol ProJxt: _New_AdEn _ARsratlon _Rep�lr <br />Show NumberlNl ol Rxtures <br />PERMIT <br />of ProJxt: _Nsw _AAAn _Alhratlon _Rsp�ir <br />Show NumberlK) ol flxfuns <br />Medical Gas <br />Other: <br />Other: <br />I hereby ceAity Ihat I have read end examined Ihis application and know the same to be Irue and corted. Ail provielans of laws end ordinencec paveming <br />ih�s ty��:9 of work will be complied with whether specifled herein or nol. The Branting of a permil dces no� presume to give eWhorily la violate or cancel <br />Ihe proviuion of any other slale or local law regulaling construdion or Ihe perloimance of consiruction. That I am aulhoNzed by the owner of Ihle propeMy <br />la pedorm �he work for w it , ppllcation is made and I comply wilh the State Coniraclon Lew 7827 RCW and 298200 WAC <br />I I , <br />wnerlAut �orize Agent Slpneture Det (RevlsedY2011J <br />l <br />( <br />Z <br />