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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMRING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, Wr'. 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM %� 3 I" I 7 <br />7 DF7�-1% f'1l1�K�� I I �O � IPROPERTYTA)Ip i PE ZOt' OI � <br />_EGAL lor new conslruction: ShoA PlaVsubdiviston_ <br />�WNER �e�c�-�ac:,Cuz-�(�'�2ti <br />4ddress �lf)� �T.�( C��� <br />4ppLICANT: _ Owner Owner's Agen� ,�Co <br />"ONTRACTOR � 9iQl�(r OM Y��C�U <br />4ddress �� �J � /i/C,e� 6- yJ, r <br />fENA�:' BUSINESS NAME <br />� f-�v�2G El <br />BUILDING PERMIT APPLICATION <br />:xisting Use of Building <br />ot <br />(atlach copy of long legel desuipllon) <br />_COfIf0C�0YSAJ2f1l _,T008IlI�mmlpmnUaeletlxMcomenifromlMowrortoEowMlnMasDKe) <br />81 Lic. # �- ! <br />� PhonelEmail �� <br />ONTACT FOR_PFR /IT / �� <br />Q(' f cr <br />ione�E•mail Lt(Q� �%3�' <br />ONTRACT PRICE OF WORK <br />d Use of Building � <br />type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />OF WORK (addifional space provided on the back) : <br />at ProJact: _New_Addn _Altaratlon _Repelr <br />Show Numbar(N) olllxtures <br />A!(: _ air Nandlino uni�s <br />0 <br />a( Use <br />APPLICATION <br />ol ProJect: _New _Addn �Altantlon _Repalr <br />Gas <br />I � Number of Heads I I I """'. - ' <br />I hereby cetldy Ihel I �aw read end e�emined Ihis app�Ke�ian entl know Ihe eema lo ba We end corted. All p�ovialons W laws anO oNinancea goveminy thin type olwotle vn! be complietl <br />x+th xTet�er spec�eC herein or noL Tho yrantinp of a petmit does nol pmeume to pNe aulhoMy to vblate or ranal Ne provision ol any W�er atete w bcal I�w repulatinq cmaWqbn <br />Thal I am auNodzeC Ey the owner ol lhia property �o De�orm t�e wwk lor xTlcb appliution b mMe antl I wmpN �� Ne Sitle Contreqon Lrx 1827 RC W antl 298 t00A WAC. <br />� ` � %-3/-/ Z <br />OwnedAut orized Agent S pnature Date (Revised fiQOtt) <br />