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� <br />�� <br />PERMIT APPLICATION <br />4� s�a 3�f� <br />BUILDING/MECHANICAL/PLUMBINGISIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — wuvw.everettwa.org <br />APpLICATI�NS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROPERIYTAX PE <br />� t v�F16 i2vs� i�c>u� E p ��� -��" <br />1L tor new construUion: Short PlaVsubdivisian Lol Na.�7_ (anach copy of lorg legal desaip6on) <br />PhonrJL"-mail <br />&I <br />d / <br />PERMIT APPLICATION <br />Use of Building <br />L� �t-�-' <br />PRICE OF WORK <br />/7l�'.�%L�,. _ K u vt $ � r C <br />�€� /NFtf'eA�F.�c ct:� <br />� �p i" �� <br />HEAT SOURCE� <br />�sed Usa of Building 5�Z � Gas Eiectric omer <br />ng type: `�Single Famiiy _ Duplex Townhouse _ Mutti-Family _ Commerdal <br />of project ✓New _ Additlon _ Remodel _ Repetr_ T.�. _ Sign ✓ prinkler _Demolitlon_Change ol Use <br />escripUon of Work (addtlbna�spece providedon Me b�rk): <br />/NSiR-LC. F�2K SP��^:KLL�25 /N <br />you started workfng wNhout a permlt7 _YES V NO <br />MFCNSNICAL PERMIT APPLICATION <br />ol ProJact _New _Addn _Altaration _Repair <br />Show NumDerlMJ ol �xtures <br />v�/L�ti S i� (%O N t R-J S� <br />o(Projoct: _Navr_Addn _Altsratbn_Repeir <br />_ I Other <br />yp Numbcr of Heads — <br />I here�y a:rtlfy that I have rea0 antl examined Inis application antl know the same to he true and co�red. All provisions of laws aM ord'mnrkes 9o`Kvnirg <br />this lype ol wotle Nill bo complied with whelher spedfied herein or noL lhe graMkg of a permil do^.s rwl presume to give aulhority lo violate or ancel <br />tho pravision at any other stale a bcal law regulating consWtlion w the performaixe oi constrWion. That I am aW�orized Cy lhe ovmer o11hLs prapeily <br />io pertorm Ihe work for whitli ppficatlon is mad and I compty wilh Ihe Stale Conlradors Law 18.27 RCW and 296.200 WAC <br />� �.-�,�L � 2- � 1 I (1 <br />OwnoAAuMorizod Agent Signature <br />Date (Revised tYN10) <br />l�� <br />