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r'ERMIT APPLICATI� <br />BUILDINGIMECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., [verett, WA 98201 425-257-8610 FAX 425-257-8857 www.everethva.org <br />PE <br />3d�8 Ntiss4� �� <br />LEGAL for new evnstruction: Short PlaUsubUrvis:on lol No._ (altaeh cepy ot long Iega� desu�plion) <br />OWNER P���a w�„a k,a��Y c��+ <br />lUOS �i�c�F�'� f��e. L�e�ctf' <br />1NT: _ Owne• _ Ownefs Ar,ent _�i <br />CONTRACTOR <br />LDING PERMIT APPLICATION <br />[xisting Use of �uilding <br />yu'- .�se • r, yr <br />ICity/State2ip Ever�ti �.J{ �iYZvf <br />_COf1If�C10f'SA9CP1 _TBf1dM�must0�=��•�'eiterdcc��:enl'cTv�eu��eibCuwo�.LtIDesoace) <br />�li Li�. tt :�J �`j � �— � Cit� <br />Pho�eEma13�D' ]3i' "7S(..!— <br />)NTACT FOR PERMIT <br />cne.'E�ma�; 3%0 - 739' 7}(p a <br />)NTRACT PRICE OF WORK <br />Proposed Use of �mlding � <br />Building type: _ Singte Famdy _ Duplex _Townhouse _ A1ulti-Family _ Gommercia! <br />Tvpe of F�oject: New Atld�6on __ Remodel _ Repa�r _ T.i. _ Sign _Spr�nkle� <br />DEtS'CRIPTION OF WORK (adc,�cna! space prev:Ced cn tr,e back) : <br />i���5� 172MOI r�')LN � l� I <br />Typc of Project: __New_Addn _Ntcrelion_Repair <br />Show Numbcr (N1 0! lix(ures <br />fVC — av hantlling units <br />Forcetl au ses;ems <br />hoad <br />Olher <br />ON <br />�us Lic dOyJ IZ� <br />T SOURCE <br />af Project: _New _ Adtln _Alteration __Repair <br />Show Num6rr (p1 0l frrfurrs <br />I Todet <br />Medical <br />OtCec <br />er <br />I � Number of Heads I I I ��❑er. __ i <br />I �erely cenAy tC+l l PdvC re:id �i�J Cwm ned Ihr arp:;ca9on nf.0 Ano'a I�e seme to Ee Irue an0 cortecl. All pmvis�ons ol IOws anC at0inon<es qoveming t�is tyye ol woik xNl Oe r.ompLed <br />��v� w�ciner sFcuTeC herein or net T�e 9ianhng cl a pmmA Eoes ncl C�esume to gire aN�onty �o v:olale or �r.cclihe provision c.' any ofAer slate ar locol lan rcgulaling consbucbon <br />TAaI I am autnen:e0 �/ ine ownei ol Ims pmperty tc pertorm t�e wvtA forwnKh appiivaUon Is made ana I compry eifh tAe Sta;e Cocvac:ois luw 1027 FCW and 294200A N'FC <br />1-� �/} ���� t0' � � <br />OwnerlAuth � cd Ayenl Sfgnalure Ua(e (Fecaed �G015) <br /><u L.,I <br />