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PERMIT APPLICATION <br />BUILDINGlMECHANICALIPLUMBING/SIGN/SPRINKLER/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 ,s � 3'�I � <br />AD�RESS: <br />lorncwcon<.Irucllon: S�art <br />CI�� <br />PERMIT APPLICATION <br />Use of Buikling ��f' <br />d Use of Building TO fit c�iF;.�tt <br />(allarli wpY ot lang legal desaipt ian) <br />S/d/��011 <br />PRICE OF WORK <br />ngtype: _SingleFamily _Duplex_TowMouse �MuIN•Family �Commercial <br />of project: _ New _Addition _ Remodel _ Repair _ T.I. _ S�gn _Sprinkler �,Demolilion_Change ol Use <br />of Wotk (additional space proWdetl on fho Dack): <br />st�rted wo�kfng wilhoul a permit7 _YES �NO <br />ICAL PERMIT <br />o1ProJecl: _New_Addn _Alteratlon_Repalr <br />Shew NumEc� /MI ol firfur's <br />Num6er <br />NG PERMIT <br />o1ProJect: _New_Addn _Alteratlon_Rep�lr <br />Shew Num6er !MI af flrfurcs <br />Mediwl Gas <br />Other: <br />Other. <br />1 hercCy reNry Uwt t have read and e.amineA b�is apptintion an0 Fnv.r ��e same to De true and conecL All ptwisbns ol4rxs anC orCinanxs goveming <br />I�is rype of watle wll be complietl wtthwhelAer sDecifie0 �erein or not. The granting of a permil docs net presume lo A��e auNomy lo vloiale or wnxl <br />Ue p�oWslon ef any oNer stale or Iaal taw �egutaling wnstNctlon or Ihe pehurmance of wnsWcllon. That 1 am autAonted tr/ U�e owner al IAI� p�operry <br />to petlorm IAe woA br �Mich appllcation Is maEe and I compry �NN Ihe Stale ConlraUOB Law 10.27 RCW and 298.400 W�C <br />?!sii/�r �A�'l/Lij�i /t1Q /bRTeFEUEReiT �/l9�lz <br />OwnerlAuthorizeJ Agent Signature Date <br />(ReNsed L2otp <br />