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PERMIT APPLICATION <br />BUILDING/MECF�ANICAL/PLUMBIN�/SIGN/SPRINKLERIDEMOLITION <br />CI7Y OF EVERETT PERMIT S�RVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257=8857 www.everelhva.org . <br />� �IG �!N <br />S� <br />�w� <br />TA% N <br />lor new conslruclion: ShoA PlaVsu6division Lot No._ (allach copy of long legal description) <br />M,� Cv �' <br />_Owner _O�Nner'sAgenl _CoNraclor �ConlractorsAgenl _Tenant�m�siFro�;doamr.�rot�o�semtmmmoow�erweowarx�nmospaw� <br />TOR L s�' S`I�-lz� State Lic. # I,POl�S-�-'f O�J P 2 City Bus. Lic. # <br />72 ! /�i3 �L S•I.v.. G�nnwa>d[ (,P�Y �Q�j% PhonelEmail (Z�— ��� —�7Yy% <br />B (.(G( �-�p t,,,rr�'J � PhonelEmail <br />6�UILDING PERMIT APPLECATION CONTRAC7 PRICE OF WORK � <br />Existing Use of Building HEAT <br />Proposed Use of Buiiding Gas_ Eie <br />Bu�lding type: _ Single Family _ Duplex _Townhouse _ Mulli-Family Co/mmercial <br />7ype of projecl: _ New _ Addition _ Remodel __ Repair _ T.I. _ Sign �Sprinkler _Demolilion, <br />DESCRIPTION OF WORK (additiona� space piovided on �he back): <br />ii <br />Zvt 5�11 ��,e S� Xf� � Q��rri��-. 3��. . <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />o' Projoct: _Now_,Addn _.,Allnrelion_Rapair <br />Show Numbcr (p) oI /ixfures <br />A/C _ air hnndlinn unilc <br />SYSTEM <br />Number <br />of ProJect: _Naw_Addn _Altoration_Repalr <br />ShowNumberlNl o//ixturcs <br />Medical Gas <br />Olher: <br />Olher: <br />I hc�eby certily Ihal I have rmd and examined ihis appliw6on antl know Ihe same lo he lruc and wired. All provisions ol laws nntl orCinances goveming t�i; type ol work xill be ramplied <br />Niih wnct�er specilicd hercin or nol. The gran���g ol a OcrtnA Cocs nat Dresume l0 9Ne oulhorfly to violate or canccl the p�ovision of any alhv slalo or Iowl law regulaling wnstruqion <br />t�at I am auNorized 6y t�e anner ol t�is propetly to pcAortn Ihc woik for wt�ich appliwtion i; motle and I wmpy mlh Ihe SIn1e CONraqors law IB.Y7 RCW antl 29G.200A WAC. � <br />� 2 <br />,�� (k � z�q�y <br />Ownur(Authorized Agonl Signaturo ' Dalc (Revised Y1013� <br />