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�ERMIT APPLICATIO�. <br />BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLiTION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org� <br />)DRESS: PROPER7V Tlllf p P MIT It <br />2 ORk-ES AvC. EueRer'i"Gt�er a92o3 � �5� <br />lor new constmchon S�orl PlaUsuGAivision Lo� No._ (a�tac� copY o110ng legal tlescription) <br />W �\ <br />N2l- <br />IGtyI5lale/Zip <br />_Owner _OwnefsAgenl ,LC Coniractor __Contractor'sAgenl _Tenantlm�sieranaoa�microico�:on:w.mmoowoc�iacowcn�..,nmspa«� <br />En5 o N <br />BUILDING M'ERMIT APPLICATlON <br />TlO/�i �State Lic. # i <br />,r�lL,�l..La. �1azi� <br />inail <br />�N�ert��9(ol <br />PhonelEmail i� <br />R PE IT <br />PRICE OF WORK <br />:xisting Use o( �uilding � <br />'roposed Use of Building �� <br />iuilding lype�. h Single Famtly _ Dup!ex _Townhouse _ Multi-Family _ Commercial <br />�ype of pro�ecf New Addition Remodel Repair TJ. Sign _Sprmkler _D <br />)ESCRIPTION OF WORK (aamrronai space provided on me backl. <br />iv�z4c�� 2 g1� F.�replc.ce5 av�d 1no�wal-er }-tink �,�s� a�••A <br />o� Project: _New _Atldn �Altoretion _Repair <br />- air <br />� <br />SPRINKLER 1 SUPP <br />Number r. <br />Cily Bus. Lic. N <br />I-�9� <br />HEATSOURCE� <br />f'vV� Al� Q Qg �� PI �1q <br />�� J <br />ol PwjeeC _Now _Addn _Alloralion _Repair <br />ShowNumbcrlpl ollirfum5 <br />sink <br />Med�cal Gas <br />olhcr <br />I hcreby cci6fy I�al I have rca0 anC c.ammco I�rs appbwbw antl Vnow Ihc ::�me lo bc Inic und mnect. All piovisions ol law: an0 ndinnnccs goveming �I�is ry�pc oi wort w11 Gc wmpl�ed <br />w.l� whcllic� Spcul:eE �emm or not ihe gmntmy ol a pc�m, Cocs �ml prr amc lo prvc:nnhomy to violntc or canccllM1c D����smn o! any olher slaic a� lucal Liw myulabng conslmcysn <br />Tha' I am autbonecJ by Ihc ownc� ot Ilils p�oM�ty lo pciioim Ihc wc�A for wMch aDphcaUon is n�a0c and I compiy wnh inc Slalo LorVaclo�s I.aw te P RCW . �� 196200� bVAC <br />OwnorlAuthori�ed AgeM Signaturc D:tle (Itemsetl Jr016) <br />