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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM R AM TO 4 PM <br />PRCPERTf TA%# I PERMIT�#�ry, AC-, <br />,uonn=� La rc � <br />�>re reft <br />98,�0 <br />Lot No. (attach copy of long legal description) <br />for new construction: <br />Short Plausubdlvisbn <br />Phone/E-mail <br />4A 5 - ?jq )f )A-70 <br />t d e tre <br />OIA I n <br />� (1 <br />9-tie Ye 11 Vv A 9 9AO , <br />3 i o I <br />0 1_ A, � <br />C rJ rf <br />CilylSlatelZip <br />Agent <br />Cgniractor _Contractors Agent <br />_Tenani(muslprovkleeblbr otcrosemeom ne owwrro do woAfo Pe rP«a) <br />:ANT: Owner <br />_Owr'efa <br />.. <br />n r ,. I, <br />r.J,Mc T <br />LBILic.# <br />ALP] <br />IN <br />E30 <br />c c a01PhonelEmailCONTACT FOR PERMIT Me n6rd <br />SINAME //I� (p� f rIc yHjou o ri .yf�t446 * Phnne/E-mall it' 2 5 ' <br />UILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1110112 <br />r) ��e11r)9- HEAT SOURCE <br />(isting Use of Building �,✓ <br />-oposed Use of Building cis Set _.. a G b od G Gas__ Electdc_ <br />gilding type: _ Single Family _ Duplex Townhouse ✓MultIi-Family _ Commercial <br />Chan <br />a,...-q,dnktnr Demolition _ <br />-ype of project: ✓ New _nuumvl, ---•- - )ESCRIPTION OF WORK <br />(additional <br />,spnaceprovidedonthe'back): Per Pre'ecj0201 3'C I <br />nru) g <br />a, <br />5 �irnaca. -ZISk <br />Re,nove CUSIot piion5; ahArn "irplrnumajas <br />,5 �kctefective, <br />-furna.c�-('us ner5rpplred) SnClu5lycoi <br />plpf�g, gas +Iu-, Ifnr ik•WSa) Iow del+aye., new!• <br />TION <br />of Project: <br />lyl <br />PERMIT APPLICATION <br />_Addn _Alteration_Repair <br />PLUMBING PERMIT APPLICA <br />of Project: _New_Addn __ <br />--Alteration <br />chew Numher till of fixtures <br />Other: <br />pe ofmik Wl be <br />I hereby ce1lM that lhave read and exeminanNis of a permit <br />doellnowthsume 10 obe ne ne authority o Noble or cancel the proProvisions Of vsiontlof any other state w local lawMulat' Bcnstluctl n4ed <br />with whether specified herein or not. The planting or a permll ewes not presume to B b <br />That 1 am authorized by the Owner of this properly to perform the work lorwhkh application is made and I empty with the Stale Convedon Law 19.27 RCW and 29e.200A WAC. <br />Date <br />OwnerlAuthoriz Agent St nature <br />(Revised &2012) <br />