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r <br />`�'ERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 v✓ww.ever�twa�.irg 13 <br />ADDRESS: %�-,/ Z <br />lar new construction: ShoA <br />�: v <br />,v, v <br />IpROPER7Y TAX p <br />AV� <br />e <br />No.,_ (altach copy ol long Iegai descriplion) <br />iil �Z��O' yc-Ci'%.��� <br />S+ ,fz,t,�cL ICity/51ale�tip <br />Owner OwnersAgenl ✓Con�raetor Conl�0c�0i5Agenl _TenaN(m�sipmNaeaieneretconsem�mmmom+nenoeowoMinmespace� <br />C <br />7yb•3a�•iS`�� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />HEAT <br />Exisling Use of Building <br />Gas EI� <br />Propased Use of Building = <br />Building type: `� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />T pe of pro'ect _ New Addition _ Remodel _ Repair ✓ T.I. _ Sign _Sprinkler _Demolition <br />DESCRIPTION OF WORK (aamnonu� spsce provided on me 6ack): <br />MECHANICAL PERMIT APPLICATION <br />ofProJocf: __Now_Addn _Altoratlon_Repalr <br />Show Numbcr (#) of lixtures <br />i e�c _ ol� h� ,nlinn uni�s <br />73�nfts���.,w.�� <br />Use <br />PLUMBING PERMIT APPLICATION <br />of Projocl: _New _Addn ✓ Alloralion _Ropair <br />Medical <br />Other: <br />I � Nmnber of Heads i i _ <br />I �erehy cetl�ry that 1 �ova read and examined I�is appl¢ntion and know t�a same lo be Iruo end corrccL All p;ovisions ol laws end ortlinances goveming Ihis rype of woik e�il Ce compLed <br />wr,h wnMner sFecifed herein or not. The granting ol a permrt tloas not prcsume to give eutnorny to vioate or cancel tha pmvision oi any oUer slate or local law reguiating consimaion <br />7hat I am aulhorrzeA Dy t�e owner oll�if propetly to pedortn Ihe �rork lor w�ich apPl�calion is mode erd I comply wf,� I�a State CONracton Law 1B 27 RCW enE 298200A N'FC. <br />/ - �' �.2�. ��3 <br />/ � Date (Revised 3/2013) <br />Ow orlAuthorized Agent Signaluro <br />% <br />