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� <br />� <br />PERMIT APPLICAT�ON <br />BUILDINGIMECHANICAL/PLUMBINGISIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., EvereR, WA 98201 425-257-8810 PAX 425-257-8857 �w✓w.evereU�rra.crg <br />AD�RESS: ^ <br />IvRorean rnx x <br />CU �,,,�,. <br />l�J <br />for newccnslmcllon: Short PlaVsuttllv�s�on Lal No._ (attach copy of Ieng legal descnpi;on) <br />. lI/...,__..i oernnrF.mal Wiil — � %%' �7 ��% <br />v� �, �/ Gve,-Ltf �''l� � � <br />NT:_Onrer _O��neisAgent <br />.^.TnR �/�� �I Z � I �i-� <br />U <br />S'i;<�PA� noM�-S <br />BUIL.UlNG PERMIT APPLICATION <br />Use cf BuilCing <br />wl} �"d' � <br />_Cro'fZC�Of'SA^yC�� _T2f1Jn1(n.vpmnacamrorNcc^s<-�iUcm�,�oon.crmn..onni'n <br />r. Inilal'T�+AZ �'76G1Cdyeus uc u <br />WSl7� 10`-'� Phvne�Ema�l l�-l.(--%�Fj —�76" <br />CONTAC FOR PERidIT /� �/ �(� �Te j� C�p aa, Q <br />� O [ 0 <br />PhonNEmail 2� —'7 <br />v— Z7 �7 ",)''+� a ,�f, <br />CONTRACT PR�CE OF WORK Z� G�v � <br />d Use of 8u��,lding I <br />lype� _ S�ngic Pamily _ Dupiex _Tovmhouse _ I.iulli-Family �Commerual <br />�ro�ect Ne�v Add�6on Remodel ReDair T I. Si�. Sprinkle <br />ol Use <br />IPTION OF WORK(add-nor,aispacepro:�eedonrheOacK)�. <br />�lq�`tc�-� G�tG19N ���V� <br />���� - �iNw+-:h4r� ) <br />IECHANICAL PERMIT APPLICATIOt�1 PLUMBING PERMIT APPLICATION <br />TypeofProject: _t7ew_Addn _Alteralian_Repair <br />lan <br />/SUPPRESS <br />of Projech _New_AJdn _Altcralion_Repair <br />Show Num6crla) a/!ix(ures <br />A7edical Gas <br />Other <br />I �ereCy ce��ty I�al I �ave iraa antl e�am�neG thls dpG�� W�ion anC knmv I�e sa:•'�e lo Ce Ime an0 cortect. f;l pmvisions ol laws antl arG'�nances goveming i�is ty9e ol ncrk wil Ee wmpi <br />wd� vil+et�er speofie0 Oeie:n r' nol Tne 9ranLn9 of a pemlA daes not pmsume lo give aul�on;y lo vialdte or wncel Iho provlsion ol Jny ol�er slale or lowl Iaw regvlapng cons W cfan <br />TTallamaW�oMteaby �eownerol;nispm e oper/o e�•�c forwAicOappil�alionismaCeandicompyvnt�IheJlaleConlnctorsLaw1A27RCWan4296.P00AWnC. / <br />a �/ � / � // � Z <br />OwnedAuthorized Agent Signalurc � Date (Revised 9R071) <br />