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PERMIT APPLICATION <br />BUILDINGIMECHANICAL/PLUMBING/51GN/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 �1 <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM 3"I S� � l <br />for new conslNclion: ShoA <br />_Lot No._ (attach copy ol long legal descriµion) <br />Owner OwneYSAgent ✓Eontractor Canlractor'SAgent TB0201(mus�proviEeabmrolcontamttamNeaweerNtlaxohlnNafpace) <br />�R �L/�,iJG /?ci,�l.. ;LQi �il.c'.� Si FtY, � s i uo. n Ci�i�1!zS /� �I �JL" COE Bus. Lic. # d/GIl�I <br />?�', ,�,y�y�{/�!/,�% / �/,6Q:ir" (,v� Zp Phone/Email 7 �7 �C���S'/LD . <br />IINESS NAME CONTACT FO.^ ' :MIT <br />�<�Cll/�%GL��1�idG �t�rHO�C�C�y .,�9 /�?r5✓/L <br />Phone/E•mail �-f2S :�.i�� �/�� — <br />BUILDING PERMIT APPLICATION <br />UseofBuilding /1'Y!//L �"i1�i�L��"'�"""L <br />r� r/ <br />d Use of Building <br />type: _SingleFamily uplex_Townhouse �-Family <br />PRICE OF WORK <br />Commercial <br />HEAT <br />of <br />DESCRIPTION OF WORK (add��iona� space provided on me qack): j,�C�qC L�C' �%i'� i�UE G�r'S h-t,��U�f'C� �r''l:V <br />.rL'.�i,�l� Ce[SmMH2 c�.e1/J �IJ�,,eJ c='�r.�P.L!,��, ,TUc'l�sLe Di-= /Jr�CTi:uG <br />�4/�i�'�'�l/`/`�,�'� C !{5 /= LLIC C-_�f5 / :�J'i:(k �f<lf/>T�n�aU� �;�n �' �o�as v�>t�� -�' <br />MECHANICAL <br />ofProJecL• _New_Addn _AlteroUon_Repair <br />ShowNumber!#1 ollixfures <br />PLUMBING PERMIT APPLICATION <br />ofProjecL _New_Addn _Alteretlon_Repair <br />Show Num6er !kl o/ /Ixfures <br />Medical Gas <br />Other: <br />i hcm�y ccrbty lha� I haw rcaa anC e.amined Ihis appt'kation and know Iha same lo ba Iruo end [ortecl. All pmvisions o1L�ws end oMinances gover.iin8 ���s type ofwork vnG ba compfetl <br />v; ��li �•.ne�het specifetl herein or nol. T�e Branling ol a pertnit tloes nol presume lo B�'o outhonty �o Nolale orcancel No pmvisbn ol any ol�er slale or local law reguWting conSVuclion <br />tlia� I am aul�onzetl Cy Ihe owner al l�is propeM �� Fertorm tho wod br whkh npplkalbn is maEe antl I complywlh Ihe Stale ConVaclors Law 1f27 RCW anE 296.200A WAC. <br />/ q / <br />_/ � �/ �/ � Q� /��,�" !f J7'> <br />'' ._'�G/�lCG�[f /�C_.: L�/L�� 4N� � i' / `'U <br />Owner/Autho� zed Agenl SlgnaWre �ale (Revised 6/2012) <br />