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� <br />� <br />PERMIT APPLICATION <br />BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar SL, Everett, WA 98201 - 42;s-257-8810 — FAX 425-257-8857 — wvrw.everel6va org <br />APPLILATIONS ARE ACCEPTED FROtd 8 AM TO 4 PM :� ` —/ Zi <br />ADDRE55: PflOFERTV TA%d PERGIIT a <br />--- . , ..,.. ,�„«��,,,�n��ay r_r�n�-0�1 <br />fcr nc•.+constmcl�ort Sho� <br />S � �it'� /� <br />� sz g � <br />,� ve. <br />BUILDING PERMIT APPLICATION <br />_Lol No._ (ai�ach copy cl long le9al descnplm�) <br />& I Lic. # <br />� �rnu�m�5 <br />PRICE OF WORK <br />� <br />8�0-Ga <br />xisling Use ot Building ��'1 � f � '� �S� n�' P HEAT SOURCE: <br />roposed Use of Bwlding �� G�s__ Eiectnc _ Omer_ _ <br />uilding type: �Single Family �Duplex _Townhouse _ Multi-Famiry _ Commercial <br />ype of projecC _ New _Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolilion_Change ot Use 1�rw� <br />e5ctiption of WO�k (addnional space O�oviOed on Me back) : (i'�e.G�j =ry !!�^� <br />(lewro•(fC �.!%5�,-a-� l�e t�'S avio� A�c� �'!t'w. /�cr�cl Dor.�reiS • valuc <br />you sWrted working with iul a permit7 _YES V NO <br />MECHANICAL PERMIT APPLICATION <br />ol ProJech __New �Addn _Allemllon _Repair <br />Show Num6cr (k) ol firfures <br />Gas lir <br />Gas ra <br />ust <br />SPRINi(LER / SUPPRESSION SYSTE <br />PLUMBING PERMIT ,APPLICATION <br />of ProJece _�Jew <br />ol liriwcs <br />Backflo++ <br />MeOical Gas <br />Olher: <br />_Repair <br />1 ncre�y cerl�ry thal I have reaC and e:aminc] �h�s app�icalion anC knmv Ue same lo be lrue and cormU. All pmvisions ol laws on0 oitl�nances qovem�ng <br />tnu rype of w•ork wi1109 fAmplied wit�w�elher speciGeC herein or noL 7�e granting ol a permil Goes not presdme to give au;nonry lo vicla'e er wncel <br />Ihe pmvision al any other stale or local law regulating wnstruction or Ihe Dertormance of eonsWct:on. That 1 am authonzetl Oy t�e o.vner o11Ns prcpe�ry <br />�o peAorm the work lor which aOPbcatiun is made antl I comply wilh the Slate Con�roUurs I.aw iB27 ftCW antl 296100 WAC <br />��., h ��.�� 3-� 9.-���z <br />j er/Aulhorizee Agent Signahre Dale (Revised L20i7) / <br />� Z <br />