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i <br />PERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 982d1 - 425-257-8810 — FAX 425-257-8857 — www.everellwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �-�a� O` � <br />fornewconslmclion: Short <br />2110 PnctHc t�V�, <br />BUILDING PERMIT APPLICATION <br />Lot No._ (altach copy ol long lega <br />Phone/E-maii <br />=d/�% City/S1aIelZip <br />t L 8 I Lic. #�VG� rsss � Z r <br />�� Phono/Email �2 �- Z <br />CON7ACT FOR PERMIT J•- IL � <br />/7fR/� <br />Phone/E-mail . C�µ <br />CONTRACT PRICE OF WORK S, <br />>ling Use of Building �F�� neni a�urc��: <br />posed Use of Buiiding OFF�Lf Gas Electric� Other <br />Iding type: _ Singlo Family _ Duplez _Townhouse _ Multt-Family � Commercial <br />�e of projecC _ New _ Addition _ Remodel �, Repair_ T.I. _ Sign _Sprinkier _Demolition_Change ot Use <br />;Gfiplion of Work (addifional space pmvided on Iho back) : L,r W� <br />RE�Jt i i�VIPt► t1a�.T �i+�`P w t'M 4� � C�ti 4�!'. rOt. DiSu�6s,�?.�t! D� <br />ON RDG� W�t� IAJfUc/�10i� (t•'i /Ywp ✓��'�� Pu' INDuy�t//y �S7AMA�✓G��.( N/iN �i� tJNJ� <br />re you started working wilhout a permit7 _YES 11,N0 w/ Id� �CL�/r►N /N(ifeP"� <br />MECHANICAL <br />ofProJect: _New_Addn _A��eration�Repalr <br />-air <br />healer <br />_Naw_Addn _Alteration_Repair <br />Show NumberlRl ol fixfures <br />Medical Gas <br />Olher: <br />Olher. <br />I hereby certify Ihat I hnve read and examined ihls applicalion and know�ha same to be We and corted. NI provislons of laws an6 ordinances goveming <br />thie �ypo of vrork vrill bo complied wilh wfiether spedfed herein or nol Tho grznling of a pennit does not presume l0 8�'o authodty to violale or cancel <br />the provision of any olher state or local law regulaling wnstmction or Ihe pedormance ol conslruclion. Tha� I am authorized by Ihe awner of this pmpeAy <br />to pedorm lha work for vAiich appliw�ion Is made and I comply with Ihe S�ate Conlraclors Law 18.27 RCW and 296.200 WAC <br />�//S/i y 1 <br />OwwNAiAh iz AgentSignatura Dale (Revlsed7/2017f `�7j <br />