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PERMIT APPLICATiON <br />BUILDING/MECHL�INICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8870 FAX 425-257-8857 www.everettwa.org <br />�L far new tonSlruciion: Snon <br />ER (InZe�I-e�/ l <br />c��SC� ,f Y <br />rr�c a <br />No._ (attac� copy ol lonq legal description) <br />Owner �wneYSAgent Con�rac�or ConlreclorsAgent TCOdOI(mustpmvi�oolv:l!rolccnscnihomL�ocnncrtoCowoRinNo%pawl <br />iR�(��' [�Y(;!� �Gl `P%���/ Slate Lic. # y Bus. Lic. # <br />t � <br />� 3� �-� � Phone�Email _ <br />BUILDING PERMIT APPLICATIf1R� CONTRACT PRICE OF WORK <br />Existing Use of Bwlding <br />'roposed Use of Building ,_ �� <br />3udding type: ^ Single Family _ Duplex _Townhouse _ MWti-Family _ Commercial <br />Tyoe of projecl: New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler C <br />DESCRIPTION OF WORK (addrtionar spacc p/ovlded on me bacR�: <br />l�c,n Cz-� /:%c 7�6 ��ne4C� <br />MEGHANICA4 PERMIT APPLICl�TION <br />ot Pmject: _New _Addn _Altoration _Repair <br />Show Numbcr �q) o! lirfures <br />A/C — air handling unds <br />Number of fieads <br />tn ,J/`fl1' E�� �r��i � <br />� � <br />HEAT SOURCE� <br />Electric___ _.. Other <br />�.mdition Chanqe of Use <br />PLUMBING PERMiT APPLICATION <br />ofProJecl: _Now_Addn _Altoration_Ropair <br />ShawNumbcrltll o//ixtures <br />Medical <br />Olhec <br />7ther: <br />I �eieCy ceiLty that I have rcaC and caamined Ih, apphwlion and know Ihe same to 6e We end coirect. All pmvisions ol laws ontl m2mances goveming this �ype ol woA will be wmphed <br />with whet�er SpecAieO �erein or not. T�o 5mnbng o/ a ec�nil Coes noI presume lo give aWMnly lo violale or cancel t�o pmrision al any el�e� stale o� lowl law regula�ing conslmclm�� <br />T�al l am aulnonzed Oy t�e oxner of this F�openy Ia petlortn the work for wTich appliwti�. �, maae an01 cnmply Wil� Ihe Slate CONfadas Law IB 27 RC W antl 296 20CF N'AC. <br />�%i��- 7 - �Y-/� <br />�CiwncrlAuthorizod Agont S�Ignaturo Daie <br />(Revised 3Q073) <br />