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� <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBING/SIGN/SF'RINKLER/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 />C..,�iP //Sn APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM %'- ].� —/'Z <br />rV <br />fornewconslruction: Short <br />_ Owner _ Owners Agenl <br />�� <br />BUILDING PERMIT APPLICATION <br />Use of Building <br />� Lot No._ (atlach wpy ol long legal descriptlon) <br />, PhonrJE-mail � Q <br />- 2os-��i �569 <br />/ <br />� Zo0 Ciry/State2ip Q <br />Contracwr'sAgent TenaN�m�s�n�•a••broroim�..m�,msow�rmaowonmmuv.cel <br />L 8 I Lic. # ST S �p COE Bus. Lit. # <br />� �0 Phone/Emaii � � Z C.' .0 Q <br />CONTACT FOR�RJJI� G.vo�W�N <br />�•� !L / �7 <br />PhonelE-mall — O Z 4— O <br />CONTRACT PRICE OF WORK • �� <br />Proposed Use of Building �-- <br />Building type: _ Single Family _ Duplex _Townhouse _ Mulli-Family �„ Comrr.erciai <br />Type ot project New Addition ,_ Remodel _ Repaic T.L � Sign `i rp inklei <br />DESCRIPTI N O/F WORK (addi�ionQal space provid/ed on fhe back) : <br />MClNs�Gf i4 Mi Qhcl �l'1l74 �� •T/�:�1 � <br />✓ <br />MECHANICAL PERMIT <br />ot Project: _New _Addn _Alteratlon _Repalr <br />Show Num6erlpl o/ /lxfures <br />Use <br />PERMIT APPLICATION <br />ProJect: _New�Adtln _Alteralion_Rapalr <br />Other: <br />NumberofHeads ' <br />I hereEy cendy t�et I have read end azamined this appliwtbn and know t�e same lo ha Irue end cortecL All pmvisione al lewa end oMnencee Ooveminp Ihiz rype olwwk vel Ee wmpGed <br />wM v.neNer spedfietl �ereln or not. T�e Branung oi a pemilt doas nol presume ta pNe euNorily to WoWte or cancel the proWson ol eny aNar stete or lofal law repulatinp consWclion <br />T�ot I em aulhorizeC by Ihe owner ol ihis propery lo pe�lortn I�e work lor whk� appkelion if ineda enC 1 compy wih Iha State ConVeclon Lew 18.27 RCW end Y86200A WAC. <br />,'[ �f'�� o�/zs/�z <br />�� /���7QL^"'�'^ fRevised 6/2of2) <br />awner/Authodzed Agent Signature �e <br />( � <br />