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� <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />��3 �� <br />ADDRESS: ?�,l' <br />E RTY TAX <br />� �4. <br />lor new construclion: Shod PlaVsu6Civision Lol No._ (altach copy ol long IegalOescription) <br />LL <br />NT:_Owner _OwnefsAgen� _CONraelor _ConlracloisA9ent _7enaN�m�.,:ip,�„eoaierc�r�i�o�s�m�rommoow�ermeo.on,;�mo:p,r,,,� <br />BUILDING PERMIT APPLICATION <br />Use of Building <br />(3u5. Lic. # <br />�O>' <br />. Bcacc ��rncu-1 �fo„.. <br />PRICE OF WORK <br />HEAT SOURCE <br />'roposed Use of Building IC..' 3 �' F� I Gas Eleclric__ Other <br />3uilding type. x Single Family _ Duplex _Townhouse _ Multi•Family _ Commercial <br />fype ol pro�ecL New AddiGon � Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />)ESCRIPTIONOFWORK/aad���onnispaceprowdedonmaback) �q�� �-R�j,� IFI'E�'M'r �r{�,� p�R er�aoF_q <br />F(�►1 S'1YhW,iA'i TO 'ISSMT, j'Z�i'1�1� 8P.6AK�2 � Ct,tD t..t R-ES "� 34nT� RNb. P,¢T10� 1�#u. <br />�1L IN 'BSrtj� K,i7GH�. �►�ST1'H.1- A�iD�T/odA� 4nOK.� D�'T�Zi'o(1-S ►YS IJn�GA7d) sr15'I.AIl4. <br />Rll vJo�Zk i/��ULio(t� . <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />of Projoct: _Now _Addn _Altcralion _Ropair <br />Shaw Number (MJ ol /iafares <br />NC — air handlinn imdc <br />air svslems <br />HCBI <br />Other <br />ol ProJecl: _New _Addn _Alteralion _Repair <br />Show Num6ci /p ol liifurrs <br />Showcr <br />Medical Gas <br />Other <br />Other <br />I �eieEy cem�y mat I have rcatl �na ernm�nrd Ihi, nppl emion xnJ knoM Ine samo to ee Ime antl ca�ren All provisione nl Isys ond oNin. nces governmq t�rs I'��! M wor4 mIl Lu compLed <br />wnh wnelhc culictl � m or not. Tne 9mnting ol u permri UocS nol D�ewmc lo grvo aulhouly lo vroinle or wnccl I�v pwasion ol an� olhcr slnlo or lowl law mgvm'in9 conslmclnn <br />ln.l 1' auiha �ma by I� Hner ol mis pwperty lo petlorm Vie wotk lot w�iU xpp:¢at�on ¢ made nnU I comply wtlh ��e Slale CoNratlor5law IB 27 RC W an0 794 TJOA VJAC / <br />� � <br />Ow rl ho tl Agent Slgnaturo Date (Rev�sed J?O1J) <br />