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From: ', O1/( ^/2012 11:57 #280 P.0021003 <br />s�3���a <br />PERMIT APPLICATION <br />BUILDING/MECHANICAUPLUMBING/SIGN/S PRINKLERlDEMOLIT�ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everettwa.urg <br />APPLICATIONS ARE ACCEPTED FROM e AM TO 1 PM ��-'3,Q .. �Z <br />•nneroc. . ..'___'_""'" _ 1 <br />ess <br />10fnewconfhuGlon: Shott <br />NG PERMIT APPLICATION <br />Euisli�p Use o( 8 <br />Pf00058A UEb O} <br />Lot No._ (etlach wpy ol lon� bpal descrlplion) <br />,o�aE�,.�� r . _ . S q2 <br />�Y,Su��a�P ���- W q�u3 <br />ai�w.n �iG iN $ <br />�� 7j y Phona/Emall�'1.5, �J�O , 7� <br />DNTACT FOR ERMIT ,� �3� 7pc�l �,� <br />ru��� cas . 4 �a <br />�one/E�mall Q <br />DNTRACT PRICE OF WORK — <br />_ HEATSOURCE: <br />3ulidinp type: b Single Famty _ Duplez _Townhouee _ Mufli•Femity _ Commerciel � <br />fype of proJect _ New ,,,,_Addilion _ Remvdel � Repair _ T.I. _ Sfpn _Sprinkler_Demolitlon_Chenye of Use <br />�escriptlon of Wotk (atld'dlonslspace proNded on fha baNq: <br />Re,Mc�v�� re.p� ace ��S �� a�.�' Iv� a��-c • <br />iava you etarted working wlthout a permlt? _YES _NO <br />o1Pro�aN: _New_Atldn _Albntlon <br />SDow NumC�r M) ol Ai[urw� <br />of <br />PERMIT <br />o/Projcct: _N�w_Atldn _Alterytlon_Rapalf <br />Medical Gas <br />Othor: <br />1 hereby cortlfy thal 1 have reatl antl ezaminotl �his aOPlicatbn antl know the aame to Ee Irue and correct. All provialona of lawa and ortllnancoa yoveming <br />l�is type of work wlll be compietl vAlh whel�er epenfletl hereln or nal Tha pranllrp ol e permit tloes nol presume to plve aul�onty to vbkte or cencel <br />the provision of any other state or locat law rcgutatinp conatruc(ion or lhu perlormance ol conatruction. Tliat 1 am authorizetl Ey Ne oxiwr ot this property <br />to pertam Ihe �+ark fwwlilU� appliralbn Is metle and I comply with Ne Stete Ccnincton Lew 18.27 RCW end 78B.20o WqC <br />_� ��'�u�— 113c�3t��T <br />n�r/Authorizod AO��� 9��ture Data <br />(Rovised 7l1017J <br />