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PERMIT APPLICATION <br />BUiLDING/MECHANICAL/PLUMBING/SIGh/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 />ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM i�% "'� � <br />ennRFcc• PROPERTY TAXp PE��T,� „ � „ � <br />for new constmcllen: Short <br />j�b D��9- 5����E-3% � Dez� <br />BUILDING PERMIT APPLICATION <br />Use of Buildino <br />'�. • . <br />Lot No._ (allach copy of long legel descriplion) <br />Phone/E•mail <br />CltylStale2lp t.-v��T �t�� 9g: <br />L81Lic.# <br />PhonefEmail ��25"3 p% i" 7...3% <br />CONTAC7 FOR PERMIT �'q�� � A� yt�C"h/ <br />Phnnw/F.mail �/1!L i n riA(1 L1 Pl"1 (Ul �: ��Ga ' <br />PRICE OF <br />HEAT SOURCE: <br />�sed Use of Building I �as_ =�c�����_ ������_ <br />ng type: _ Single Family _ Duplex _Townhouse _ Multi-Family �ommercial <br />ofproject: _New _Addition _�model _Repair�f.l._Sign_Sprinkler_Demolilion_Change ofUse <br />�iption o( Work (additionel space provided on the back): <br />�Ri�O� /✓�' �'jib �L% C� E C�.f�7'L�- <br />you started working without a permlt7 _YES ✓NO <br />MECHANlCAL PERMIT APPLICATION <br />of ProJeet: _Naw_Addn _Alteratlon_Repalr <br />SPRINKLER <br />of Heads <br />NG PERMIT APPLICATION <br />ot ProJeet: _New _Addn _Alleration _Rapalr <br />enew N�mberlNl o/ flxfures <br />Medical Gas <br />Olher. <br />Other: <br />t hereby certiry thal I have read and examined this application and know the snme to be true and cortect. All provisions of laws and ordinances goveming <br />ihis type of work will be complietl with whelher specified herein or nol. The grenling ol a permit does r.ot presume to give aulhority lo vlolate or cancel <br />Ihe provision of any olher slate or local law regu�aling consiruclion or the pertormance of conslruction. That I am authorized Cy the ovmer oi this property <br />lo perform Ihe work for which applicalion is made and I comply wilh Il�e Stale CoNractors Law 78.27 RCW and 296200 WAC `I v <br />" -�7 -I <br />rlA orize AgentSignature Date (Revised212011J <br />