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( <br />PERMIT APPLICA�ION <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 — www.everettw�or�`( Z <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM oZ " y <br />N�'c .ssQ � <br />(ornewconslruclion: Short <br />0 I�1 P2 c�{-;c: f�✓e. <br />OR C : A CL� '.91 <br />3�io c �Jf�uf .�` <br />ISINESS NAME <br />IG PERMIT APPLICATION <br />Use ai <br />d Usa � <br />,ON.. <br />� <br />0 <br />— Oc�—E <br />�( No._ (ettech copy ol long lepal desaipUon) <br />iail �as— as9� 5 � �5 <br />Zip <br />Ev'e �'c l`� �,GJ�� 9' °u.�2 0 ( <br /># � oZ Nl.t. <br />.�1 Phone/Email �a5- 339 -3i�� <br />\CT FOR PEf}MIT n <br />rN''��ICQrl�11Q <br />PRICE OF WORK <br />��ti�,b�Jlcf'e�a. c <br />ng lype: � Single Family _ Duplez _Townhouse _ Multi•Family _ Commercial <br />of projecl: _ New _ Addition _ Remodel _ Repelr _ T.I. _ Sign _Sprinkler _Demotition_Change ot Use <br />'iplion of Work (additicnal space provided on fhe back) : / � 0.�� 0 Z, <br />�itrx.o✓�¢-rcc'c/C 'fl��li,a,,J'e, a,�...qi CI�LL/C7c_ �nv <br />started working without a permit7 _YES �NO <br />FcwnNICAL PE RMIT APPLICATION <br />ofProJect: _Naw_Addn _Alteration_Repalr <br />/ <br />PERMIT <br />o1ProJecl: _N�w,_Addn _,Altentlon._Rep�lr <br />Sherv N�mAer !/1 0l flxfUrfi <br />Medical Gas <br />Olher. <br />� � Number of 4eads � � � Other: <br />I hereDy certiy Ihat I hava mad and ezaminetl ihis appliwlion antl knav lhe same to be tru� and wrrect. All provisions of laws antl ortlinanrns goveming <br />ihis type of vrork will be wmplied wllh whether speciGed herein or not. Tha pranting ol a pe�mit dces not presume to give authonly to Holale or ca�el <br />ihe provision ol any otner state or local law regulating construclion or ihe peAortnance ol cunsWctlon. Thal I am autMdzed by ��e rnrner ol lhis pmperry <br />to pedorm the wo r whi a lication is made and I comply with the Stala Contraclors Law itl.27 RCW anE 298.200 WAC <br />fit��� �/a3�/az ,Re�S�, �ot„ <br />OwnerlAuthnrized Agenl Slgnatura Date <br />