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�ERMIT APPLICATION <br />3llII r�INGIl�!IFGNANIG4! IP�U!�!�IR�GlSICa.R�/�PR!!�!KI FR/r�FMC�! !TIQN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everelt, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: <br />�ornewconstruclion: Short <br />►J <br />p <br />No._ (attach copy of long legal AesoiptionJ <br />Phone/E�mail <br />� <br />_Owner _OwnersAgent J Comraclor _ContracmrsAgent _TenaM�m�:�c�o��aeaie:m�i�o�so.,i��ormo�,.��o�ioeoHoni,u�a:w:�� <br />i�F�lNf��! �V�✓B�7T <br />BUILDING PERMIT APPLICATION <br />Use of Building <br />� a i uc u / Cc-�SI "JzvC� coe s�5. u� ; <br />F�T�/- honelEmail�.� 3��;� I' VO�jO <br />CONTACTFORPeRMIT ��/�.> N�m% ��Or� <br />v�� <br />Phone/E-mail �173��jrj/�-('�d7�O LL�S�T�( <br />CONTRACT I'RICE OF WORK IDi 3� O_ — <br />roposed Use of Building I �as_ tieanc_ ��ner_ <br />uilding type� _ Single Family _ Duplex _Townhouse _ Multi-Family iG Cammercial <br />ype of projecf New Additior Remodel Repair x T.I. Sign _Sprinkler _Demolitio�_Change of Use <br />�ESCRIPTION OF WORK (add�t�ona7ispaceprowdedo/n thebacH). <br />2� IocA-�e /�3 I'C�NGiA�tIT .�OI�1 N � ( �/��j -�o � -1-e�� �4.v�i in��ro� <br />MECHANICAL PERMIT APPLICATION <br />of Projacl: _New _Addn _Altorallon _Rapalr <br />Show Numbcr (p) of lixfures <br />A/C - air handlinq unils <br />SPRI <br />o( Heads <br />h �YSTEM <br />PLUMBING P'eRMIT APPLICATION <br />o1ProJoct: _Now_Addn _Alloration_Repalr <br />Show Numbcr fq1 0/ lixtures <br />Medical Gas <br />Other: <br />Other: <br />I �ereby cttliry Ihat I have read and examine0 t�is app'ication ai.E knox I�e sa,+�e lo be tme antl wrrect. All pmvisions ol laws an0 ordinances goveming t�is lype al work wtll oe complieC <br />with w�el�er speafed h>rein or noL The granlmg of a permit aoes no� presume to give authonly lo violate or wncel Ihe pmvision ol any other slale or lural law �eyutatmg wnsimcno� <br />T�al l am ul�onzed Oy Ih owner ol Ihis propetly lo Ferlorm Ihe woik lor whic� a0P'���ion is made ana I wmpiy m�h Ihe State Conlractors Law 1827 RCW an0 296 200A WAC <br />+i�� %�V'���fiG�'�i�% � Z Zd��— <br />OwnodAutho�i d Agent Signature Date IFevisey 6R0+2J <br />.r. <br />