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PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425•257-8857 www.everettwa.org <br />lor new construct�on� Shon PlaVsubdivis�on <br />ANT: _ Owner _ O�hners Agent <br />rax a <br />No <br />a <br />(attach copy o� lon� leyal dexnpl�on) <br />Coniractor ^ Cc,�lra[lofs Agent _ Tenant �m�.i o�o.�ar, m:er o��,ne,i nor mf vy-� ioyo �..cn n <br />ILDING PERMIT APPLICATION <br />Ezisting Use ot Bwldmg <br />State Lic » �, / (RJ /� �Ay 9us Lic.: <br />:i1 (Q ,: o�e/EmaJ `i25 / a r - � <br />CONTACT FOR PERMIT <br />jeSsr�li � Gro�.,�n�p •��r�- <br />Pnane/E-ma�l Y2K- y8�r -�44 � <br />CONTRACT PRICE OF WORK � 3, L�LO. (S <br />Proposed Use of Bwldmg c) Ll V✓�_ <br />9ci!d!ng type� _ Single Family _ Duplex _Townhouse _ Multi-Family <br />DESCRIPTION OF WORK �admnonai space p�ov�ded o� rne bac�� <br />1�2 I bCA-�ln �- �3 S��'1 n�(e r�� �` <br />MECHANICAL PERMIT APPLICATION <br />ol '�ew_Atldn _Allcration_Repair <br />...v Num6er /pl o/fiymres <br />SPRINKLER I SUPPRESSION SYSTEM <br />Numher of Heads <br />PLUMBING PERMIT <br />ol Projecl: _New _Addn _Alteration _Repair <br />PiVFIRi <br />Medical Gas <br />Other: <br />I Oere�y CeN�y Iliat I �ave rea� an0 e.aminea Nis appOralron ana Anow Ne same lo Ce Uue ana cortE[t Pll pmvisions ot I:iws an0 arEinan[es qovemmg Ws Irye ol work vn:l �e comp <br />wCh whclMr spec5etl herein or nol 7�e granlinp ol a pemnl0ocs no� Oresume to give:iutnon�y lo valatc or ctnu� Il�c pmnvon ol any ot�cr stale or IOGII L]w mguWung unsirutl�on <br />T�at I am aul�anzeE Uy Ibe owncr ol llvs D�Derty lo pedom� I�e wed br w�r1� aOG���Ocn is maae and I rvmpy �r:h lne Siale CoNractors Law IB 27 RCW anA 29G 200A WAC <br />�(�J1�.w-, `i��; Vv� � ( �-1 � ( �6 <br />OwnedAu horixed A nt Signature Datc (Revised 920fa) <br />�! Z <br />