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� <br />� <br />PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/UEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />;a. PROPERTYTA%71 <br />far new conslruclion: Short PlaVsubdivlslon Lo� Na._ (allach copy of Iong legal descriplian) <br />Z� <br />VE�G e�o� �Fs� ti <br />BUILDING PEi2MIT APPLICATION <br />Existing Use of Building <br />CilylSlale/Zip � E �10 � <br />,S�li/�1 L81Lic.# ��� G lV.i�33C� <br />�L �T ��p 2�� Phone/Emall 2,�� / Sv • Vc <br />CONTACT FOR PERMIT <br />'(� Phone/E-mail �111C� � ` �- 1— <br />, ._ <br />CONTRACT PRICE OF WORK .j ' nr,r )0� <br />HEAI� S�URCE: <br />Proposed Use of Building �i t�$ �� � Gas_ Eleclnc_ Other_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family �� Commercial <br />Type of project: _ New _Addi�ion _ Remodel _ Repair_T.I. _ Sign _Sprinkler_Demolilion �Change of Use <br />Description of Work (addifional space provided on fhe 6ack): <br />Have you started working withaut a permit7 _YES „�NO <br />MECHANICAL PERMIT APPLICATION <br />TypootProject: _Nuw_Addn _Alloration_Ropair <br />Show Number (#) o/ /ixfures <br />/ �i <br />PLUMBING PERMIT APPLICATION <br />otProJect: _Now_Addn _Alteralion_Repalr <br />Show NumberlN) ol �xtures <br />Medical Gas <br />Olher: <br />� <br />I hereby certih� Ihal I have read and examined Ihis application and know Ihe samo to be true and conect. All provisions of laws and ordinances goveming <br />ihis lype of work will he complied with whelher specifed herein or nol. Tha granling of a permit does not presume lo give authorlly lo vlolate or cancel <br />ihe provfsion o( any other state or local law regulating conslruction or Ihe peAormance of construclion. Thal I am aulhorized by the owner of this propeAy <br />to perlorm lhe work for whlch applicat� de and I comply wilh ihe Slale Coniraclors Law 1827 RCW and 296.200 WAC <br />;���� � I�Zs�iol� <br />OwnorlAutl� rized Agont Signaturo Dat (RevisedY2011) <br />1 <br />%a <br />