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PERMIT APPLICATION <br />BUILDINGIMECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM / 7- `-D� � I/ <br />"^"..... �.... oFnwr r <br />for new wnslruclion: Short <br />� <br />PERMIT APPLICATION <br />Ezisting Use of Building <br />Ptoposed Use of Buiidir <br />(allach copy allong legal <br />.- � . � —7; � G <br />PRICE OF WORK <br />�ng type: _ Single Family _ Dupiex _Townhouse _ Multi-Family _ Commerciat <br />ofproject: _New _Addition _Remodel _Repalr_T.I._Si�n_Sprinkier_Demolition_Change otUse <br />�-10 urSe +' G��`rc� � <br />U <br />of Work (atldifional space provitled on fhe 6ack) :�`mD <br />J/� ef/U��cof�A�,���� l N%���E�l�.�i��,t�G�i�/iV� <br />MECHANICAL PERMIT <br />ProJect: _New_Addn _Allerelion_Repelr <br />Show Num6er (N1 0! Ilxfures <br />o1ProJecl: _New_Addn _Alteradon_Repair <br />Show Number fN) ol flvtures <br />Medicel Gas <br />Other: <br />I hereby cetlily thal I havo read and examinetl Ihis applica0on and know the same to be truo and conccl. All p�ovisions ot laws and oMinances goveming <br />this type ol work vnll be wmplied vnlh w�elhcr specifed herein or nol. The B�ntin8 0l a permil dces nut presume to give authority to violate w cancel <br />the provision of any other slate or Iocai law regu�ating construction or Ihe pertormance ot consiNction. That I am aut�orizM Ey the owner ol this properry <br />to peAor ihe work for which applicetion is matle anE I omply with Ihe State ContractoB Law 18.27 F,CW anE 296.200 WAC <br />� � f- � ��a'/ � <br />OwnerlAuthorizetl Agent Signatura Dale (Revised 7/2011) <br />