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WP�y51 <br />PERh91T APPLICATION <br />BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: PROPERlY TAIf N PERM�T K �, �� ./ <br />�� n.� o, i � iu�i....s.� a� Lil lYXI/7�000n�{i01 �> /�,•�.� — Q:i. <br />_EGAL for new conslruclion: Short PlaVsuDdivision ��� <br />�WNER P�i ��iaiE 1T1"� Phone/E-ma <br />4ddress �'i'.0 � - 13 W /.7 atvistate/zi <br />CONTRACTOR Q �"�% J L 81 Lic. # <br />4ddress�{/l �/V1PG�IMI . u/l�'I' !flu�i(i �`^! /O� <br />tEN/�AN.T BUSINESS NAME CONTACT <br />/./ �'% n�1NU%u� "�• ' • phone/E-ma <br />BUILDING PERMIT APPLICATION CON7fuc <br />No._ (attach copy ol lang legal descnption) <br />C' 73a3 <br />�, �A 9d� 3 <br />�if1D� <br />�j-�3�-dzzz <br />�{25-7�0 �l b <br />PRICE OF WORK ��S <br />Existing Us� of Bu��ding �"L41:�1►i1 UAIALNTw✓1P HEAT SOURCE: _ <br />nG'i.FiLtNt�/vt�lrl,uvril.w'At h 0.. <br />Pmposed Use of Building Gas Electnc Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi•Family _ Commercial <br />Type of project: _ New � Addilion _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demoiilion_Change oi Use <br />Descriplion of W ork (additiona! spaco provMod on fhe backJ : ,r <br />A'faT /S�KO�Af,�/47p� �k!'+b� e1ClSnNEr lcR�aU,ND h94t�{oK bRdn.�D-P6U,ch'1���"r� <br />� �€G� A�bDmoN•Nlnw�oNm..�y�c� �e �cu/y.� � +tc�om�m��o.v���/����r�N.p�iuJnN � <br />Have you started working wilhout a permil? _YES �NO 1.���' �- �ITU`+'T /•1°"�"" <br />MECFIANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />ofProJect: _New_Addn _Alleratlon_Repalr <br />otProJect: _New_Addn _Altaratlon_Repalr <br />Medical Gas <br />Other: <br />1 hereby certify that I have read and eaamined this application and knaw the same to be we and correcL All provi,ions of laws and ordinances goveming <br />lhis rype of work �+ill be complied with whether specifed herein or noL The granling of a pem�,;l does nct presume to give autMnty to violate or cancel <br />the provislon of any olher state or lotal law regulating consWction or the peAortnance of canstruc6cn. That I am authorized by the owner o( this pmperty <br />to pedorm the v.ork for wfiich appl�cation is mado and I comply v.ith the State CaNracrors Law 18.27 RCW and 296200 WAC <br />pw�.r� ��zq�l <br />~ho I¢ed Agent Signature Date (Revised 2Q011) <br />[,o� <br />�L <br />