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PEaMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVIGES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />D ROM8AMT04PM �� `�� `� �� <br />ApPLICATIONS ARE ACCEPTE F <br />ADDRESS: <br />for new conslruction: Short <br />BUILDING PERMIT APPLICATION <br />Use of Building <br />rnxa I ���'�)%JO' <br />I No._ (allach wpy of long legal descnptiun) <br />PhonelE-mail !/ZS " 4 �G /� <br />City/StatclZip �VG'(L['TT <br />L& I Lic. # N FkrE G[r � <br />Phone/Email y Z � : <br />CONTACT FOR PERMIT ��� y <br />Phone/E-mail G�Z,�'.j��10� � <br />ICONTRACT PRICE OF WORK `�/e <br />�Ai✓,QC�t.' <br />RCE: <br />Proposed Use of Building � <br />Building lype: _ Single Family _ Duplex _Tovmhouse _ Multi-Family _ Commercial <br />Type of projecl: _ New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_,Change of Use <br />Description o( Work (additionel space provided on the 6�ck): <br />e��-��oF�,�.���.�� <br />� you started working without a permit7 _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />otProJoct: _New_Addn _Altoration_Repair <br />Show Number (N) o! Rxtures <br />PLUMBING PERMIT APPLICATION <br />o(ProJect: _Now_Addn _Altoralion_RoFair <br />Medical Gas <br />Other: <br />� NumberofHeads ' <br />I hereby certify ihat I have read and examined Ihis application and know lhe same to be lrua and cortect. All provisions of laws and erdinances 9oveming <br />Ihis type of work will be complied with whether specified herein or not. Tha granling ol a permit does nol presume to give autho;ily to violale or wncel <br />lhe provision af any o�her slate or local law regulating conslruction or Ihe peAormanca ol conslruction. That I am authorized 6y Ihe ovmer of Ihis property <br />to peAorm e work for whic appf lion is made and I comply wilh the State ConUactors Lew 1827 RCW and 296200 WAC <br />i ��� /0 -/5� %/ <br />OwnarlAulh zedAgentSignature <br />Dale (Revisetl2l2017J <br />