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� <br />� <br />PERMIT APPLICAI'ION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOL.ITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar SL, Everetf, WA 98201 425-257-8810 FAX 425-257-885� �w✓�v.everettvaa.org <br />1 �—i 3 —/� <br />A�DRESS: �O / LOCUS � ,S <br />E� <br />lor nEv: CC.�SIr���iion'. Short PI�U;�btlrvi5ron lot NO <br />P�onCiEm�il <br />ZoU%C)Uu DO � AA ( �I � �� Q <br />�al�ac0 copy otlonglenalAe;cnpCon) <br />>.'Zs'"% iJ2 � <br />�oX is y7 I�;,,s.a��-Z�p E"��`,��Tl �✓�/ i'�'1 a6 <br />, <br />Oxner _O.vnersAoenl _CCnlraclo� _Con(ratlor'SAgenl _Tenant�mu;;;rc.�Ccalerero'm�v.en5�-,n�o�ne:ah.<'.�;.i�e <br />���v���w <br />BUILDING PERI'�IIT APPLICATION <br />Use a( �wlCmg Sr� <br />Stale Lic. ; <br />Phone�Finall <br />CO4TACT FOR PER��IIT O <br />Pno,z,�.m��� yzss� � <br />CONTRACT PRICE OF WORK <br />8�5. Lic.: <br />J <br />oposed Use o( Buld�ng � � ;,as V Eiectnc otner <br />iilding type: _ Sin51e Family _ Duplex _Townhouse ✓ Mulli�Family _ Commerual <br />pe of projecC _ Ne:v _ AdtliVon RemoCel �Repair T.I. Siqn SD�inkler Demolipon Cha�qe o <br />°SC'RIPTION OF WORK (atltl�honai space p�oeided on Ihe back) �. <br />C'//H�✓Gr AT l�f/��/.1 �/�fli�2: <br />L PERMIT APPf.1CAT10N <br />ol Project: _New _Addn _Ahcration _Repair <br />Show Number j#) o/lirfures <br />NC — air handlinq unAs <br />Forced air svslems <br />Water <br />� Olher <br />SPRINKLER I SUPPRESSION SYSTEM <br />Number of <br />PLUMk11NG <br />Typc ol Projecl: __New_Addn _Alleration V Repair <br />sink <br />CIOIhCS'NdShCf <br />Waler healer <br />drain <br />Medical Gas <br />Othec <br />I �eic�y cen'Y L�at I �ave matl ana en..rnincb Na xppLciGon an0 kn�n Ne ume lo Ce W e 2�C m:mq. q7 pmvisicns ol tnr en0 ortlnances pavemL^�g Ns fy➢e ol viaM vn0 6e mmp� <br />��9h w�cJm� ;peu5e4 �Crein o� not. IDe qranUnq ol a pe:mA Cacs nnt pm;ume la g�ve aeU:or.ry t0 violate or wncel l�e F�o�ison ol any o:hci slale ar local Inw regulaUng conslmcLcn <br />lnai I a I� +eG oy Ine o�.mer ol NI5 pmGeM io pedcRn �ne wo�k Icr wY.c� ap0��ca�ion is made an� I ccmpry wi�h Ne S�a!e Cm✓artcrs Law 10 27 RCYJ an0 79G 3COA WAG <br />//- / / <br />Ownedfv �fo ecd Agent Signature �a1e (Revised 9/1014f <br />! <br />