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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBINGISi�NISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />320Q Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www•everettwa.org <br />AppLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />J�v i��-; I IS ��9r'_!� ��' <br />_EGAL for new conslruction: Shorl PlaVsubdivision_ <br />�WNER fNI-;t vl� •� N,� �,Gi��� IAJ� <br />4ddress <br />CONTRACTOR S 2-1 F <br />4ddress <br />TENANT BUSINESS NAME <br />BUIL�ING PERMIT APPLICATION <br />Exicting Use of Bi�ilding -s ��Q� �• a-��-�� <br />No._ (attach copy ol long legel <br />uG �1 ZZ-� 20'�- (�JoI <br />Lic. # <br />k.� y7� -7a��r <br />honelE-mail U)�1� �^ <br />�ONTRACT PRICE OF WORK <br />N^ Sv� � ( � .�.. <br />�O� � <br />HEAT SOURCE: <br />-U <br />Proposed Use o(13uilding_ �Zl�' �Z'.� •�-�` � �' i"r'_ � � Gns Eleclric Other <br />Building type: ]� Single Family _ Duplex _Townhouse _ tAidt� ily _ Commercial <br />Type of proJect: _ New _ Addillon ,� Remodel _ Repafr _ T.I. _ Sign _Sprinkler _Demolitlon_Change of Uae <br />Desc�iption of Wo�k (adJifional spaca piovided on fhe Sack) : <br />(�"-(11N_t i,�r.l.�(..a ��.}� e.� � ��nJ� �i' � -� rJ ��.. <br />pou started working wtthout a permit7 _YES X NO <br />ICAL PERMIT APPLIGATION <br />o1ProJoct: _Now_Addn _Alleratlon_Ropalr <br />ShowNumberlMlo!lixfures __ <br />PLUMBING <br />of PrcJecL• _Now _Addn _Alteration _Re�alr <br />shnw ^umAerlMl olflstures <br />Other <br />I hereby cetlify tha� I have read and examined this applicalion and know Iho same to be irue and conect. All pmvisions of laws and ordinances goveming <br />this type of work wlll be complied wilh whether specified herein or noL Tha granling o1 a permil does not presumo to give aulhoriry lo violate or wncel <br />Ihe provision of any olher stale or local law regulaling conslmclion or Ihe pertormance of construction. That i am aulhodzed by �5,e owner o1 this property <br />to pedo the wO� lor � hich� ' tion is mnde and 1 compty with �he St.le Conlractors Law 10.27 RCW and 296.200 WAC <br />( / �/.7�1� <br />�norlAuthorized Agont Ignaturo Dale (Revised 1?120f0) <br />'/ Z <br />