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PERMIT APPL".CATION <br />BUILDINGIMECHANICALIPLUMBING/SIGN/SPRIi�KLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES )�- g 13 <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 w�wr.everettwa.org <br />APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: �����7 SG r k.(��� Mall PROPEZ�OxS� ` ISU� P T�� <br />l. i�� <br />lor new constmction: Short <br />� <br />_Lot No._ (altach copy o1 long legal descnption) <br />H�2 <br />C 1'� <br />_Owner _OvmefsAgent �,Contractar Contractor'sAgent _7enantlm�:�vro.aoabr.�ro�co�soo�nommea...�eri000Hoamma.Po�e1 <br />PERMIT APPLICATION <br />Existing Use of Building <br />Lic. #«�'' �� �U������" COE Bus. Lic. # <br />�b�Z Phone/Email �Z � l.1`b1'� (p (p _I <br />TACT FOR PERMIT <br />SeS�c�l���zs �iy���� 4 <br />,,�M„� � ��,�in �crn�(� <br />PRICE OF WORK <br />sed Use of Building_ �2-21� Q�� I Gas_ <br />ig rype: _ S�ngle Family _ Duplez _Townhouse _ Mulli-Family � Commercial <br />�f project: _ New _ Addition _ Remodel Repair T I Sign �(Sprinkler _Demolit <br />:RIPTION OF WORK (additional space provided an the back): �, . <br />(�D� �zs 1 �a \ti -Foc -t��a�4 irn�co�� me(��; a,�;> �e�lace <br />����1,����w de,,;ce �.,,k� �n �' akks �s7p�DA- <br />MECHANICAL PERMIT APPLICATION <br />ofProJeet: _New_Addn _Ailcrallon_Repalr <br />G� 3i��Ie C <br />PLUMBING PERMIT APPLICATION <br />al ProJect: _New_Addn _Altcrotion _Repalr <br />Shmv Num6er (IX) of fLrtures <br />Medical Gas <br />Olher: <br />o �� <br />I hereby cenlfy ihat I haw reod ond eraminetl ihis application antl know Iho sama �o �o Irua antl wnecl. A�I provisions ollavrs an0 aNinonces goseming Ihis rypo afwork will bo comptied <br />vrah vAether speci(ed �rrein o� nol. The granling o/ o Dertnil tloes nol presume lo OWa nul�onry lo violalo or wnce! Iho pmWsion ot any olhe� stale or local law regulalin8 �onnbuqion <br />T�at I am nuUoiizetl by Iha mvner olihis pmpeny lo pedarm iho vmrk lorwhic� appfmalien b matla ontl � compy wM1h Iho Sla�e Conimctors Law 18.27 RCW ond 296.200A WAC. <br />�;', j�� �v� ���:�� ,z J���;z ���_ <br />O Aer/A��orized A9ent Signaturc Date (Revisetl 6/2072) <br />