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f <br />PERMIT APPLICATION <br />BUILDINGIMECHANICAUPLUMBING/SIGN/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 PROM 8 AM TO 4 PM <br />ADDRESS:r� / �`` ��£� �tL PROPERTYTAXN P MIT1 �"1 <br />b 7 � <br />LEGAL for new consWction: ShoA PlaUsubtlivfslon_ <br />DWNER �t�►�f �� <br />4ddress � /� C� r <br />CONTRACTOR � ���"�X �r� <br />4ddress � �� � � � 5� <br />iENANT BUSINESS NAME <br />BUILDING PERMIT APPLICATION <br />Existing Use af Building <br />No._ (attach copy of lonp legal description) <br />. �f2S �t-�'s _2�� <br />L& I Lic. 71✓ � L-��� 03 2 <br />C�I <br />IPhonelEmeil �d.� �O` p3F� <br />OR PERMIT <br />PRICE OF WORK �Ei �'� � � <br />HEAT SOURCE: <br />Proposed Use of Building ' ---- --- "— - <br />Building type: _ Single Family _ Duplex _Townhouse _ Mulli-Family _ Commercial <br />Type of project: _ New _, Addilion _ Remodel _ Repair _ T.I. _ Sign _Sprinkler,_Demotilion_Change of Use <br />Description of Work (additionel spece provided on fhe back): <br />��� <br />you started working without a permit? _YES _NO <br />MECHANICAL PERMIT <br />of ProJect: _New_Addn _Alteration _Repair <br />ShowNumber(#1 o//ixtures <br />SPRINKLER <br />SYSTEM <br />PLUMBING <br />TION <br />otProJeel: _New_Addn _Ak�radon_Repalr <br />Show NumbeilMl oI flxturos <br />Medical Gas <br />Other. <br />� I Number of Heads I I � V1OC1. _ <br />I hereby certify ihal I have read and examined Ihis application and know ihe same to be true and correct. All provisions ol lawa and ordinances goveming <br />ihis type of work will be complied with whether specified herein or nol. The granting of a pertnit does nol presume to give authori�y to violate or cancei <br />Ihe provision ot any other sta�e or local law regulaling conslruclion or �he perlormance of construc�ion. That I am au�horized by the owner of �his prapeRy <br />lo peAorm ihe work lor which applicati n is made and I comply with Ihe State Conlractors Law 1827 RCW and 296200 WAC <br />OwnerlAuthodzed Agent Signature D��� � (Revised 22011) <br />