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� � <br />PERMIT APPLICATION <br />BUILDINGlMECHANICAL/PLUMBINGISIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PFRMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX �125-257-8857 www everettwa.org <br />ADDRESS: <br />Tax a <br />;or nevi tonstruction- Short Pla'JsubOiv�von Lot No. � (avach copy ol long legal descripl�on) <br />t �Au}soJ L�e 2cS C��J -%�C' PhonelE-ma�l �AcJe6o b a Co,�tc.�,T Ne� <br />1 S COS s'r S� c�ryis�aie�z�c L�e2p"� [,�JA _ r'!fi- 2oE� <br />��ANT: ✓Owner Ovmer'sAgent ✓Con(racior ConlractoYsAgent _Tenan!�m.�;�cc.�aoamne�a«-,;c,:i-:m�noc.�•ruao..ca.,�i�o:..�m1 <br />nr.rnR f�lk��soni �..A�� �G! �ZO"i� �'{" Stalc Lic # y,�µr,Jsoi. ���a �S S City Bus Lic # <br />T 5 <br />BUlLDING PERMIT APPLICATION <br />Exisling Use of Bwld�ng .— <br />Proposed Use of Bwlding <br />Build�ng type: �Sic�le Family _ Duptex _Townhousz _ <br />Type of pro�ecr ✓New _ Addition _ Remadel _ Repar <br />DESCRIPTION OF WORK (addncr.a� space prowded on rne va:K1 <br />�� �o�.� <br />MECHANICAI. PERMIT APPLICATION <br />of Prqech _New _Addn ___Alteration _Rep�rt <br />Show Numbcr (NJ ol lirtures <br />I AIC _ alr hannlinn unds <br />Other <br />�,-,.ri.exf e.A.� e. <br />>noneiE�ma�i 4-23t- yo5i <br />�ONTRACT PRICE OF WORK <br />Idulti-Family _ Commercial <br />T.I. S�an Sprinkler <br />� s� Ca n�c 4zT. NG�— <br />a�.G� ��s,� G�....risi.N <br />AT SOURCE <br />PLUM8ING PERMIT APPLICATION <br />olProject _��New_Atldn _Alleration_ftepair <br />ShawNumbcrla)o/lirtures . <br />Metlical <br />Other. <br />I � NumberofHeads I I � 1p1C- — ' <br />I Mmey cemly thal I have rea0 anE mam�neC iAis appliw�ion antl knax ��e same to Ee Irue antl mnecl Ail pronsions c� la.vs anJ orCmances govem�ng i�is IyCe cl wark w�u be ccmp'�cd <br />ydlp x�E�her specFieC herein or not Tlle graNmg a1 a pe��t Coes �ol presume l0 9rve aWnordy to v�olale or canccllne provrs�on of any atner staln or local law �egu�atmg conshudion <br />TOat I am autha�i:e0 Oy I�e ownef ol IN5 proD=�y Io perlorm I�e wotk 1ot w�¢p applicatian i5 ma0e anE I wmply w/� t�c Slate Conlraclo�s La'�v 10 27 RC W anp 296 200A WAC <br />�� ��- r N- �3 ��L <br />OwnedAutharized Agenl Signature L�ale (Revised3i20i3) <br />