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i <br />:s=.?7M't r •:M, "lam.-•',?.��.7.wR':Prs' <br />t ' <br />PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <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 a AM TO 4 PM PERMIT # . _ <br />for new conviction: Shod <br />TL <br />_,Owner _ owners Agent <br />PERMIT APPLICATION <br />r•Vu.11•1= <br />(attach copy of long legal <br />'J <br />contractors Agent _Tenant (maa lvovWe a hoer of mnremaom Ne ownerm eovorknmeaWml <br />L8IUc.# J �- <br />=/ j 0 PhonelEmall <br />CONTACT FOR PERMIT <br />Sft V> L+A Ua P")4 <br />Phonrf&mail <br />cnNTRACT PRICE OF WOR <br />Use of Building <br />d Use of Building %a U-v -- <br />ty.pe; _Sin leFamily —Duplex Townhouse ,_ Multi -Family <br />__ _ o—ir T.I. <br />FIONSOF WORK (additional s tic PSG S o tha6ack): <br />of Project: _Naw_Addn Meridian __Repair <br />of Project:Add^—Alteration �Repalr <br />Gas <br />Number of Heads <br />01 a panne does not presume to give eud,onty to vldate or cancel the provision of any other staid arlocal law regulating cunstmsi on <br />1 heresy eoneY that 1 have reatl tine examined this apdkagon end Imow the same to be true and correct. As provisions or jam and ordinances govnming this typo W work be compiled <br />weh whether rectified herein a naL The granfn9 with the State Conbdotora 1.111 9.27 RCW and 299.200A WAC. <br />Thal I am authorized by the spoor of this proPedy to pddo^n the work torwhch eppication � made and 1 comply I <br />(RevisedW0t2) <br />Dale <br />Owner/Authorized Agent Signature <br />