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rf <br />PERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITI7N <br />CITY OF EVERETT PERNIIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257•8857 wvnv.Pverettwa org '/ <br />G'„ ;-%a /3�i �- `� `��f <br />tax n <br />x <br />.ur new wnsUuction: Short PlaVsubdivision Lot No._ (allach copy ol iong ley�l descnpl on) <br />LICANT:_Owner _G:mels�gent _Conlraelor _CoMractofsAgent ✓TenaMiR�.,sicm.�aoaece�ci:c�serartcmmocM,or:oeo.ca��.�osPa�e� <br />TRACTOR State lic. # City Bus. Lic. # <br />�ss Phone/Email <br />ANT BUSINESS NAME CONTACT FOR PERMIT /' <br />l� i � Phone�E�mail ��/ �/`� �`L 1�/V <br />ILDING PERMIT A PLICATION � , CONTRACT PRICE OF WORK <br />Existmg Use of Building <br />Proposed Use of Buildmo <br />BuJding rype: _ Single FamAy _ Duplex _Townhouse _ <br />Type ol projecl New _ Adddion Remodel _ Repair <br />DESCRIPTIONOOF e�ad�ona�spacep vidq�ontnebacki�. <br />/Y.� J' y� � <br />��c�' ���1-� �� <br />MECHANICAL <br />TION I I � PLUMBING PERMIT <br />Type ol ProJect: _Now _Addn _Alleration _ftepalr <br />Show Number (M) ollixtures <br />I A/C—airhandlingunits <br />6oiler <br />hood <br />of Heads <br />of Use <br />ol Project: _Now _Addn _A�toration _Repair <br />Show Number pq al lixtures <br />Wa'�r <br />Medical <br />Other <br />ION <br />I �ereDy mnAy that I �ave read and e.amnietl I�is oppl¢ainn ,tntl Anou I�e same to �e Irce antl mrtec! Ail prm�i=ions ot laws antl crAinances govmning t�is lype al worA Mvl �e compM1ee <br />Nnn �Me�ner speciricd nerem or not lnc grannng o� a v��mit does not C�csume to gnc au�t;my to vioUlc cr wnccl �nc provivon ot arq otncr state or local Ww regula�ing consiructian <br />T�al I i ilhonzeE by Nc owne� oi i�is propeny lo Oetlorm I�e worA Icr wn¢h a:pbtal�on is matle anC I cemp:y wii� t�e Slstc CoNm:tore Law IB 27 RCW an01?G 200A \M17.C. I <br />�2 <br />Owned utharizotlAgontSignaWrn Dale ,Revrsed3?013) <br />