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, • � <br />PERMIT APPLICATION <br />BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar 5t., Everett, WA 98201 425-257-fi810 FAX 425-257-8857 www.everettwa.org <br />3 -10-"I <br />ADDRE55: -"' u!1 � I(.. �...� m r n... (� �..: i n PROPERTV TA% q P�'N�. n,, _^^ 2 I <br />u <br />for new conslruction�. Snorl <br />�� <br />_ Owners Agenl <br />+C�S 1l \ rn <br />No., (atlach mpy ol long legal description) <br />Conlractor Conlractor's Agent <br />t�,i�Cil�'� 1N �Y' tate Lic. # <br />EI S u�bor d�e Ch�ih <br />BUILDIPlG PERMIT APPLICATION <br />Tenant �mmi o�o.�ar o mner oi co�srm o-or mo ow�o� io aa woa m I�o spa<e) <br />u�. a <br />IPhone/Email ly2s,—� Jl 7 S <br />fAC FOR PERMIT <br />zS�q3�-�sC� I (� \1 <br />�/E-mail 0���,� • ,]�i..h�J,� � 1L�1 <br />TRACT PRICE OF WORK I UU � <br />ExishngUseofBuilding fl(J.� 1Vs1_CIY\ � <br />Proposed Use of Building Y�Sk�.vra:n � <br />Builtling type: _ Single Famdy _ Duplex _Townhouse _ Multi-Family �Commerciat <br />Type of project: New _ Adddion �Remodel Repair _ T L_ Sign _ Sprinklei <br />DESCRIPTION OF WORK�add�t�onaisn��eprovidedonmeback). <br />� ���} I M(JfbJ'einanl' <br />MECHANICAL PERMIT <br />Typo ol Pro�o�t: _New _Addn _Altcratlon _Repalr <br />Show Numbcr (q) o/ llxtures <br />ION <br />�Q� �1I Gt/If . <br />PLUMBING PERMIT APPLICATION <br />of ProJect: _New _ Adtln _Altcration _Repair <br />Show Number (p) ol lixfures <br />Othcr <br />Othcr. <br />Gas <br />8 <br />I �ereby ce�Ay Ihni I �ave �eatl antl e�anunetl I�u appScabon and know IAe samu to Oe Irue nnA co�rect MI prwl-,ions ol laws nnd ai0�nances 9overning I�is lype olwmk vnil be comphetl <br />wAn whelher specA�ed hemin or not Tpe 9rdnting ot n pertnt does not p�Mame �a grvo aulnouly Io vioi�le ur cancel t0e pmvrsion o1 any olner :late o� lotdl laa m9ulal�ng consiruction <br />T�al I xm aui�or¢ed �y I�e owner ol lqis pwpe�y lo Oertorm I�e wmk lor w�icb oODI¢alion is mu0e on01 comply x+tt� I�e $lele ConlradoR law 10 27 NCW and 29G 100A WAC \� <br />� <br />� .`-- � 2 -z�- ��9 <br />OwnerlAuthorized Agent Signaturo Datc (17evised .7/20IJ) <br />