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� <br />PERMIT APPLICATION <br />E3UILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/UEMOLlTION <br />CITY OF'e�VERETT PERMIT SERVICES <br />3200 Cedar St., EvereK, WA 98201 - 425-257-8810 — FAX 425257-8857 — www.everetiv <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �b � <br />7DRESS: PNOPERTY7A1:� �+ I'i <br />IARu�.I D2. FJFQ,EZf �NA � � <br />fa nurr conriruaion: Snon PlaUacbtllWsbn Lot Na._ (aneeh wDY ot brg legal tleacn{+ <br />.,,1,�.,t.r� SA 8L E' 't� <br />��o.�t�, wA 982og <br />o�l RoFS �r,"IriB <br />.�zs-Ls.g-Ls�� �,�,ur�.w+ezP <br />/• <br />BUILDING P�RMIT APPLICATION CONTRACT PRICE OF WORK T ��}.Ol] (MK.i1,y QakQ►�Cj�C <br />ExislingUsao�Bulltling c uG� £%�N�w HE4TSOUP.CE: <br />Proposed Use of Building Si� ��-E �N� Gae_ Elcctnc �tt�er __ <br />Buildin9typ8: �Single Family ,_Duplex_Townhouse _MuIG-Family ,Commere;al <br />Type of projeCl: _ New _Addition CL Remodel ,.� Repair _ T.I. _ Sign �SprinWef _Demolition_Change of Use <br />D05C�ipli00ofW0�k(ad0ltlonNspecbA��dadonfhebsck):wo�D F.REP�Ac6S � D�Q.Ec.� ��� E:�C,��r <br />M�c AV�. P.64t.Ac�N4 '[WC E��SYtN4 ���r• <br />SlaRed working wilhout a parmlt4 �,.,YES Y NO <br />pERIVIIT <br />of Prolact: �New,_AtlEn �. Alteratlon,�Repalr <br />o) ProJocC _Naw_/lddn _Alieia{Ion�Fiopalr <br />Other: <br />Gas <br />I hefehy certity tng� I heVe fead and examinod this epp�lcalion and knav the 98me lo De VuB end CareC6 A�I ptovision6 0l lews and ofdinarCe9 poYefning <br />thi6lype of Work Nill oU complied with wnether speGllea herein or not. TTe prenting of a ceRnit does nol presume to 9ive authonty tu violaU: of cancal <br />the prrnl�ion of any Mhef stale or bcal taw regulating cros4uUla� or tha pedormence of ca,.wCim, Thet I am authorize0 by the owner cllhis propeny <br />to ped0:m U�e wonf IOf whleh upplica�An is m9de end I Comply vAth the tat Cmvecto`s �aw 1827 RCW and 296200 WAC <br />.t ,� <br />OwnadAutb rl nt3lgnatura P'e � (ReviseC?2071J <br />