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�� <br />PERMIT APPLICATION <br />BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVI!:ES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />P�DRESS: ` PROPERTYTAI(p ERMITN <br />ile�4 LocY.ba�o 0.�t- I <br />fornewconslruction: Short <br />j C� CCOYnWt.��. <br />�4 Go....bn.�, cw� <br />Lo� No._ (attach wpy ol Icng legal descnption) <br />E-mail Z01r Z SO ' a 1 Ql �• <br />.NT:_Ovmer OwnefsABent y�C�onlractor ContraclofsAgenl TC�2nl(mus�p;ovNe�k�krolcoroanlhominao.w�eiiaGovmMinNespece� <br />cTOR C t'�S �r� ��oi(e ho+'ne Sv� L81Lic # CNO� Cl15o33 Du COEBus.Lic.# <br />Qo Ooy. �15`I Svw�+om.�h w�. SoLSI Phone/Email <br />APPLICATION <br />S�o N ;bo —S1o8•l9ao <br />-mail <br />;ACT PRICE OF WORK � �� <br />isting Use oY Building � <br />�posed Use of Building <br />ilding type: �, Single Far.iily _ Dupfex _Townhouse ,_ Multi-Family _ Commercial <br />^e of project: _ New __ Addition � Remodel Repair T.I. _ Sian Sorinkie <br />ESCRIPTION OF WORK (atlditicnal space pmvided un the back): (� � <br />F...�A ���.t- L V.c�� �'4S� '�'o t�l.0 '�GS }��Ce�QCA- . <br />ol PioJecl: <br />PE RMIT AP <br />_Addn _Allera0on_ftepair <br />IS <br />PLUMBING PERMIT APP <br />Use <br />otProJect: _New_Addn _Alteratlon_Repair <br />PAedical Gas <br />Other. <br />I hereEy ceriM Nal I hnm read entl ezamineG N�a opP�Kalion entl knax I�e sema lo bo Imo end mrtect. All pmvlslom ollawa enG oNinanas goveming II��S rypo olwwk xiA Ee compGed <br />wilh wTel�er 5petifie0 herein or nal. T�a pantinp ol e Dertnit tloea nol prosume Ia pNe euVionry to WaWte or cnncel lha praNsbn ol any o•ner state or local law repulatNp conetruction <br />T�al l om euNanzed by �ho ownerolNis properry �o pedorm tha work lorwhk� eppticalion le mado end I compy w3� Ihe Sle�o CanUacion Law 1B.2i RCW and 298.20DA WAC. <br />��~ � � � 1 � ' 1 ' � Z� <br />OwnerlAuthorized Agent SI aturc Date <br />(Revised N20tt) <br />