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PERMIT F►PPLICATION <br />BUILDING/MECHANICAL/PLUMBINGISIGNlSPRINKLER/C�EMOLITI�N <br />CITY OF EVERETT PERMIT SERVICES 3��3 —I a_ <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 - www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />for new construction: Shoh Plal/subd <br />2t« rl i ✓� s /�� <br />BUILDING PERMIT APPLICATION <br />I f-s � U� <br />Lot No._ (attach copy ol lang legal tlesulption) <br />ionGE�mall <br />tylS�ate/ZiP �v-t.�� , G(/fQ ` ! �i Zo � <br />81 Lic. <br />� P�onelEmail �/ ' Z )� - Z S f - % Z � � <br />DNTACT FOR PERMIT <br />ionGE�mail <br />DNTR4CT PRICE OF WORK �� 2 <br />°xisting Use of Building fa�t+Z�ti HEAT SOURCE: G. <br />'roposed Use of Building �- •�•^ a c;. 'L Gas_ Elecinc_ Olher_ <br />3vildingtype: _SingleFamily _Duplez_Townhouse _Multi-Family _Commerciai <br />rype of project: _ New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />)esaiption of Work (atltlitional spaca provided on the back) : � N I TK�-�-T� dvJ O/L j/F Z�( � <br />?�Z 4 � woc,p <br />G-UIWk�c'- ��� Tth�i iz,c�� Y,P;cv cr=� /1-�-�/�' <br />yau started working wllhout a permit? _YES _NO <br />MECHANICAL PERMIT <br />o1ProJecl: _New_Atldn _Alteratlon_Repair <br />Show NumEer !p) o! lDef�res <br />Gas <br />Number of <br />PLUMBING PERMIT APPLICATION <br />of ProJect: _New_Adtln _Alterelion_Repalr <br />Medical Gas <br />Olher. <br />Other. <br />i nereby certity that I have read and ezamined this appliralion antl knrnv V.- samo to be true and wrrec4 All pmvisions ol laws and ord'nances gover,iing <br />Ihis type of work will be complied wilh whether speciGed herein or noL The granting ol a permit aoes not presume to give aul�only to Mo!ate oi wncel <br />Ihe pmvisioi ol any otAer state or local law regulating wnslruction or the petlortnanco ol constmction. 71�at I am aul�orized by Ihe owner ol this pmperly <br />lo eAamine xork lo/r wJhic� applica;ion Is mada and I wmpry wit� tha State Controctors Law 1e.27 RCW antl 296200 WAC <br />� ��/ "..XJ�- � ' %' � L <br />Owner/Authorixed Agenl Siqnalure Dalc (Revised 7/Y011J <br />/ y <br />