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� <br />�ERMI1" APPLICATION <br />BUILDINGIMECH�:NICALIP� UMBINGISIGPd/SPRINtCL�R/DEMO�ITION <br />CITY OF EVERETT PERhlIT SERVICES <br />3200 Cc�iar St., Everett, WA 98201 425-257-8810 FAX 425-257-8E57 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: P0.0PER7Y TA%11 PERMIT C <br />�e a 7�c��a 9,�� cJa y s� 3 � a- ao � <br />for ne.v conslruaion Shon PlaUsubOn ,�on _ Lat No _(aL•a�h wGY of Icn9 I�gal desrrDLon) <br />t Td N IbSs �iIACSbL[�'L� Phone'E�ma�l <br />�80% F✓Er�/EEF( � <br />__ OKTIC! _ �Ni1ei5 A9CI1� _ <br />� <br />lR��,.-�i� <br />��jl�ss sho�S���� <br />BUILDING PERMIT APPLICATION <br />�SI <br />v� 1�87�� 3 <br />_ConVac]or'sAgent _Ten;nt�-�an���auc.•�mm�v*^,no,,,m.e...,:oco...�mv:��o.�m1 <br />8 I Lic # <br />:OE Fius Lic # <br />P�ondEmad <br />OR PERMIT <br />�' �l �� <br />3bo d93 �oZ a <br />PRICE OF WORK I 3 /n �D <br />Use af Building KY�TH'1 I HFAT SOURCE: <br />d Use of �uilding /7E �/ll � Gas_ <br />lype� _ Single Famdy _ Duplex _Townhouse _ MuiG-Family � Commerdal <br />�ro�ect New Addihon � Remodel Repair _ T I. 7( Siqn __ Spnnkler _Dei <br />'.I PTION OF W ORK ; adQrtwnal space p�ov�tletl on fhe back) �. <br />REwo�� n/d �',�� ��,rs'f�tfl I�(��J S�gw <br />MECHANICAL PERMIT APPLICATION <br />olProjecC _New_Addn _AlMralion_Repair <br />II <br />of <br />� <br />uon_Change ofUse <br />f��v f�-�,� � � <br />�r,�'" � <br />PLUMBING PERMIT dPPLICATION <br />ol Projeeh _New_Addn _Alteration _Ropair <br />Shaw Nurnbcr !pl ol �rtunrts <br />MeCical Gas <br />Other <br />Other: <br />I hcrcDy rntlM ��� � nave maa ana enmme0 i�u �pp'r�0o^ a�d know ttro sime lo Oo truc antl mrteU NI {wnzons ol L�ws an� oNmanros govemmg Uis type al v:otk w7 Oe mmpLetl <br />mt� wlicllier :,yca5c0 nerem ar nol fiu paninp ol a pem�a tices no� premmn lo qrve autliomy en vio�le or emcel the G���^ ol anyol�cr s4l�o or kr�l law rtpuLiCn9 mnsM1udnn <br />Thal I am aut�or¢ea by Uc amcr al Nrs C�oq�iry lo perla�m Ne vr��k br vm� appi�cnron s maCo an01 mmp,y wil� Ine Siaic CamnUor.law 18.17 RCW an0 29fi 70�A WAC. I <br />/J _ , � �'��'/13 � Z <br />�/if /J/ <br />Owner/AWhonzedAg�c� n��atum D te (Rev�scrlfi�1017) <br />