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� <br />PERMIT <br />� <br />APPLICATION <br />BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVEREIT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />l�� I �l5 <br />i A�DRESSt rn _ if .. /i / ... / PIIOPERTYTAI( N REIUIR M, <br />rornewconswctlon: snon <br />No._ (anach copy oi long lepal deacrlptlon) <br />'�J�.�— � <br />OMner OvmolsAgeat VContractor _CantraclorsAgenl _Tenanl�m�.ipo�eeatceroim.,��mrm�ueo�.��rieao..00-Mm. <br />IR State Lfc. #� fiTf 3' Ciry Bus. Lic. # W33 <br />±� � G,/tp( l.U/� (�J/i ��l Phone/Emell pZOb " /�/' Da �� <br />il S CONTACT FOR PERMIT �� <br />C%I ! <br />Phone/E•mall �20� - 7/9- aas�3 <br />G PERMIT APPLICATION CONTRACT PRICE OF WORK a�O 9• <br />use or euad��9 <br />Pfop0.5ed Use ot Bullding I Gos " ElecWc Other <br />Building type: _ Single Family _ Duplex Townhouse Mu Famiy _ Commercial <br />Type of proJecl• New Addition _ Remadel Reoair T.I. Sipn Sorinklei OemollUon ChanBe of Usa <br />DESCRIPTION OFi�ddition Paca pmvidodan thebeck): ` <br />�� ������� �������-���� <br />APPLICATION <br />_New_Addn V AlteMlon_Repalr <br />Show NumWr fpl o/ firfuns <br />aiProJec1: _New_Addn _AllenUon_Repalr <br />Medlcal Gas <br />Olher: <br />I AeroAy ceNfy Net I have read on0 eramine0 t�is eDD��en an0 Mnnw the seme to be We and mrrocL Ac pmNsbns ol inMs and oNinences govemsg Nie lyye of r.vM vnll Ee mmp <br />whh xfielher apeflfied Ae'ein or not �e grenOnB ol n DarmA daas nol o�sumo !a gHe eulioriry �n vblela or cancol No provlslon of eny olhar slale or locel Ww mBulatln8 rnnsW rfWn <br />Tlia� l am e dke yNe cvmer I�mOetly to�/ I�oy�oA �orwfilrli aOGruubn 19 meEa and I compy wtth Ne Stale Cantropon Lnw 1877 RLW onC 388200A WAC. <br />Q ��% ,�_ / <br />Own r/AuthoNeed on Slpn�lure �� Dato � .(ReWsed9R014) <br />