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❑ <br />� <br />PERMIT APPLICATION � �� 56 � <br />BUILDING/MECHANICALlPLUMBING/SIGN/SPRINKLER/DEM�DLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 �+n✓�v.everetiwa.org <br />OPER7V TlU( tt <br />(or new conslruclion: ShoA AlaVsub�ivision Lot No._ (atlach capy ol �ong legal descriplion) <br />ER <br />f/� <br />C !/tet T/- Lu4 9� �-U <br />VT: O++ner OwneYSP9ent ConiraUor Conhaeter'sFgent _(/Tenant�m�.i,o:a�aic,e�crm�secii�mvao.nvmeo.e�i,inoscace� <br />:TOR � N State Lic. X City Bus. Lic. �/ � <br />P�one/Ema�i <br />lUSINE55 NAME �U� ��. CONTACT FOR PERh71T �s �Z DYS� <br />vLr6D Q6��1zE�' <br />� PnonelE-ma�l R M1/(.(/%Z/�ii�% �iA�.:�i�@V�S•Lo�y <br />NG PERMIT APPLICATION CONTRACT PRICE OF WORK � o0 <br />Ex�sting Use ol8uilding <br />�sed Use ol Building _ �_ <br />ng lype _ Single Family _ Duplez _Townhouse _ �tulti-Family _ Cam�nercial <br />ol prc�cU New ACdd�r.n Remodei Repair ___ TJ S��gn _Sprinklei <br />CRIPTION OF WORK (aCc!:cr,ar spac_ wo��Ccdcn �ne r.uc�). <br />�er ✓P �v,h2� �toc�se 2�.���r,� <br />MECHANICAL PERMIT APPLICATION <br />ol Projcet: _Nmv _Addn _Altcralion _Repair <br />ShmvNumbcrfbl o/I�xfures <br />a�r <br />Number of Heads <br />HEATSOURCE: <br />Demo!ihcn Chanae of Use <br />PLUMBING PERMIT APPLICATION <br />af ProJeel: _Naw_Adtln _Altcration_Repalr <br />ShowNumbcrlpl ollirlures <br />Medical Gas <br />Olher: <br />I r.ereby certdy Ind I have rc.d ond e�aminc0 Nu , pp'.:aPcn . ntl Ynp,y I�C ;ome lo Ea true antl correci. Ali prov�sun, ol Isvs and armnenees governing mis type o1 wcrh r:; I�e comu'� �rJ <br />wob whe�her spenfieC he:eln or noL The 9�an6ng cl o permi' Cecs nd p�e;ume Io ome a Whonty lo rlo�ate m ca�cel4�n prorislon ot a.iy ol0er slate er lowl law reguialing mnilm:ben <br />Tl�al I am aNq;�,zc0 hy ihe owner oi ���s pmpetly to pertortn Ne wcik fer wp��c1 app�.caiion L maGe anC I comply wM f�e Siaie Ccn!raua�s Lsw � 9 7 J RC W a�d 195 20^A V:aC <br />%� �% I�� l�Z <br />Owncr/A�thorized Agene SignaWre Dale (Ra�,se,73i2UtJJ <br />