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�ERMIT APPLICATIO� <br />BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMC)LITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-6857 www.everetriva.org � <br />6� �—�S <br />: ADDRESS: PROPERTV TAX N PERMIT M <br />`� � � C,n c.�s -E- S 1 oos�s 9Z oo /�o v o v - 0 2 <br />iAL for new conslruction� Shon PlaVsubdivision Lot No._ (ariach wpY a� long Icgal dex�0tion) <br />E`U��ETT <br />.�%.3��7z7i <br />ddress�OlyC�X ��7 � �CirylState/Z�P E' /k=/�E // GI/f/ %� G �'� — _ <br />f <br />,PPUCANT:�Owner _OwnersAgem Conlractor ComractorsAgent Tenantw���o�o.:aooior.a�oiw�:emr�mmoo�enoao�nmmoso� <br />:ONTRACTOR NQ�y�!% S�ate Lic. k,A'N pbA-C 19ID � Z Ciry Bus. Lic. �Z���7' <br />�dd�ess P�one/Email <br />�EnNANT BUSINESS NAME CONTACT FOR PeRM1T ,9N0 y/�FLTMF <br />L/�Clj �/�V /'C, v'� PhonPl[�mail � � 7 �� �6 �.% — ��i� 7 <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of 8uiiding J�F� <br />Proposed Use of Building �F/� �� <br />Oudding rype: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />OF WORK(addilional5paceprovidedontheDack): <br />�'e�IG�ce ho� ����t��v l�.�vl-e,�� �n,+-►�a.cv <br />MECHANICAL PERMIT APPLICATION PIUMBING PERMIT APPLICATION <br />ol Pmjoct: _Naw _Addn %� Al�eration _Repair Type of PmJect: _NeM� _Addn _Alloration _Repalr <br />Gas <br />Number of Heatls <br />1 heroby cMify I�at I �nve rca� n�tl r.raminatl Ini: appheilwn nnd know Ina :amo lo �o Irve . ntl [aRecL All pmvlsions ol lrws antl or�inancos gowm�n9 ihls �ye ol wmk w��l Drt comp' <br />wnn wnelner s,-^ufic0 nemm or not. TTo giaMmg ol a Dcrmil aoes �at pmsumo l0 9nn autnonry In vlalalo ar nncel lno pmvi;�on ol any otner stalc orlocallnw rc9utilinp consiniclion <br />TTaI I am aul� m Ey 1� � ol l�u prope�y to pedorm ��n woik 1 r w�l apptiu�4on 1, ma0e nnG I eompty Mi� It�o S�alo Lontrac�ors Ww 1017 HCW ana 396.700� WAC <br />�— �l��,s <br />Owncr/Aulhorized A9ent Sig�aturo Uale lRevrsed aR015) <br />