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PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITIOh <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />for new consiruction: Short <br />tlE <br />p <br />x <br />No._ (atlach copy ol long!egal description) <br />;, 4zS- 26/� 5�d.33 <br />�: <br />4NT:_Owner Owner'sAgenli�.Contraclor _Contrador'sAgent _TenaNcm�sicrov�aeai.nera+w�semo-omaao»-oe�uao.oM��mesve�e� <br />1CTOR (�2C .t, State Lic. #I�iZECKL�D�Z N City Bus. Lic. # <br />3 ,r� /� �P �Nu �-f-�Q�—�^ Phone/Email Z�'JGCJ�✓�D <br />V �/�� <br />" BUSINESS NAME CONTACT FOR PERMIT <br />PhonelE-mail <br />)ING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />HEATSOURCE: <br />Use of Building <br />�osed Use of Buildinc� � <br />iing type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />: of projecl: New _ Addilion _ Remodel _ Repair T.I. _ Sign _Sprinkle <br />iCRIPTION OF WORK (eddrtiona! space providedon tho back�: <br />pPMn�l�l� o� cxis-r;�.,� F3UiL�,w� <br />MECHANICAL PERMIT APPLICATION <br />of ProJect: _New _AdAn _Alteratlon _ftapair <br />Show Mmiber(N) o/lixfures <br />I A/� — air handlina units <br />of Use <br />PLUMBING PERMIT APPLICATION <br />oiProJecl: _Now_Addn _Allcratlon_Ropair <br />Show Number (A) ol lixfures <br />Other: <br />Gas <br />� Num6erofHeads � <br />I hereby cemty Ihat I hora reaA and ezamined �his eppliwhon and know tha same to De Ime ond cortect. All pmvisions al laws entl ordinances goveming I�is typo . ork will be complieC <br />w�th whelher speofietl herein or nol. The gi, neng ol a permA does not presume to giva aulhority lo violate er cancel Ine pmvision ol any ol�er stala o� local law regulating consvudion <br />T�at 1 om euthonze0 Oy tAe owner ol ihis pmpetly to perlorm Ihe wo�k lor w�ich applicaM1on Is made antl I comply wnh t�o Slate Contractors Law 18 27 RCW ana 2°6 200A N'AC. <br />l�i 1�G�/1.��/�OP��'/ <br />OWnerlAuthorized Agont Signaturo Date <br />(Revised 3l2073) <br />