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i <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGNlSPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereltwa.org <br />APPUCATIONS ARE ACCCPTED FROM 8 AM TO 4 PiVI �'�3 ' � Z <br />LEGAL for new consiruclion: Shorl <br />OWNER LGt'�U !1 <br />- 3 �f <br />T�X p <br />No._ (atlach copy ol long legal description) <br />'PUCA4T: Oemer OwnelsAgent Contractor _Conlraclor'sAgent _TenaN�m�vcro��aaaioao� <br />)NTRACTOR 8 � ! it. # � <br />aress t � 1 �,l/(fj%(� PhonelEmail <br />!NANT BUSINESS NAME � �1 CONTACT FOR PERMIT <br />/� t ^l� <br />� �(,r e � PhonelE-mail � � <br />UILDING PERMIT APPLICATION CONTRACT PRICE OF WORK _ <br />Existing Use oT Building <br />P•oposed Use of Building I <br />Buiiding type: _ Single Family _ Duplex _Townhouyz _ Multi•Family X Commercial <br />'i ype of project: New� Addition Remodel _ Repair _ T.I. _ Sig�_Sprinklei <br />DESCRIPT10�1 OF WORK`(addNona� space urovided on fhe back) . <br />MECHANICAL PERMIT APPLIC;ATtON <br />otProject: _Now_Addn _Alteratlon_Ftopalr <br />Shaw Number (a) oflixfures <br />NC — air handling uNls <br />—� Forced air syslems <br />Numher o( <br />Bus. Lic. # <br />PLUMBING PERMIT APPLICATION <br />ol Project: _New _Addn _Alloration _Ropair <br />Show Numbcr (ql ol /ixtures <br />Medical Gas <br />Othec � <br />Ina spaw) <br />I hemGy ce�dy IMt I have reaC end examined i�is appllwtion and know I�e same to be Irue anE corrM. All provisions oi laws and orCinances goveming ihis y7a ol �w�R ��il be completl <br />wit0 whe�ner specificd �ereln or not. The graNing of a permil0oes nol presumo lo gWe autnority to violate or cancel i�e provisiun of any olner stuie or lowl law regulaCng conslruct�on <br />Tnat I am aul�orixe0 uy Ihe owner ol this propetly lo perlortn I�e work for which appliralion I5 maGo antl I campy wil� I�a Stale Lonlrocloro Lew 1027 RCW antl 296.200A WAC. <br />�,/�/Q��� �-� (�j � �2 <br />�� <br />Ovi rlAulhorizetl Agent StgnaWro D le (Revised 6/2012) <br />