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PERMIT APPLICATIOIV.--� <br />BUILDING/MECHANICAL/PLUMBINGISIGN/SF�R�NKLER/OEMOUTION <br />CITY OF EVERETT PERMIT SERVIC�S--� <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 owwr.everettwa.or `Z <br />APPUCATIONS ARE ACCEPTED FROM B AM TO 4 PM %— �� <br />ADDF;ESS: -7 �j�J PRQPERTYTAXtt �_� 4 PE Tq <br />� l0 !��- ��CG� Y11.� CG��r- ��,� LCj`.-d;c7 S�C.i > <br />laf nCw CAn5INC40n FhOrt <br />No _ Iattach wpy of long legai tlescnpnon) <br />�tl ��..��7 `� � � . ?� l`i <br />v' ��S .Z �''11� C71_ �� C �_ c tvistate�z P`�1U `�:+1"Y'�1'�l I��l �� CT�S ✓`� �P <br />� ? <br />Owner Gwner'sAgent Contractor Con�raclofsAgent _Tenartim�++o���a.e�e�e�='�^s°""'O^'"BO"^e�+�ao..�+�.�P.sor.e� <br />DR ��i;J� �'Y,l �II,t�..l,V 11 � �,n' 1 L 8 I Lic. # SI '�1(�G� 1.�Ci'� 51:,r coe s�5. u�. u <br />��1 7(,'-�+I� J�_ j���� ��Tl'�I�7���1'�( `� rC7 Phone/Ema�i7�YL"�{��,'j IG2JLi��!Ii�t���A <br />iSINE55 NAME CONTACT FOR PERMIT� _ \;, �f�il <br />�'�.:�1�i (.2 �l `-� � - <br />.,.--,� _,,, � , ;,I � �� . 7 1�1 � I <br />PERMIT APPLICATION <br />Use of Bwlding <br />PRICE OF WORK <br />d Use of euiltling <br />type�. �SingleFamity _Duplex_Townhouse _MWti-Family _Co� ercial <br />..e t P .nNew Atltlilion nemoaei ���pa_ <br />DESCRIPTION OF WORK (addinonai space pmwded on the Dack) <br />MECHANICAL PERMIT APPLICATION <br />clProject: _New_Atltln _Alteretion_Ropair <br />Water <br />Gas fn <br />Gas r. <br />d <br />ol ProjecC _New_Addn _Alteration _,Repair <br />� <br />L n"1 <br />I nme�y certiry t�al l nave maG an0 exammeA ihis aDGLc�ian and know Ine same to �e Ime anC eortect Au V�ov¢ions cl iaws an� oNinances govenun9 tn�s eype ot worl. w�ll M' cOmD�ca <br />w�;n wneiner /s earreE nerem or wl TTe grantng ot a permd aoes no1 pmsume to 9rve autnonty lo ruiate cr cmcei tne p�onsion ol any otner s�aie or bcal law reguNU�q consWcuon <br />Thai i am aup�+etl y3Ce owner al mis pmpeM �o perlorm �M1e work torxT¢t� apphcatan rs maae an0 i campry ��In me 9ate LonlraGors Law 18 27 RCW ana 29G IOOA WAC � <br />� � ` L <br />j � -�- ��'l7 <br />�_._�-- �\ � ' <br />Owncr/AuthorizetlAgentSi naWrc <br />Date (Rev�Setl 62072) <br />