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PERMIT APPLICATION <br />BUILDING/MECHAI�ICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />�,_�a--I: <br />-�� ( Sc.�llll��i� <br />tor new conslmction: Shorl <br />(�'1���I,,',� I <br />%L .5U.1'n�;i,l. �.:i .. <br />TAX p <br />Isubdivision Lol No._ (atlach copy of long legal descnption) <br />Ti I� �� �1� ano�eie-ma��i: Zc�•� "�Yy �i �.Z I ��'(�-r:.,,ir.,, �{r' � I�,fFu;l. <br />� City/SlatelZiP �;,'�!'1 i� f'", �vr�� � U'� �' I <br />LICANT: Owner Owner's�genl ,_Canfraclor ContractofsAgent TenaNtm�s�am�reeaimereim��emo-vmmeo..nermao.o�x�nme:cacel <br />TRACTOR � �L `��+� I TL'��I I �; � L 8 I Lic. # COE Bus. Lic. # <br />� .. � � � 1 �/�� .. �: �. �� i. �� �� i `� �. V � Phone/Email � �t'J � _J `/ `% - ,YI.' � � <br />!SS v... �, 11��f4'I'/,1. �f'�b�_ <br />4NT BUSINESS NAME CONTACT FOR PERMIT ,�,1; <<��a� � ?;,� M' <br />� ii W i1 :� r� �'_ �:.�1 3�i.�— 'rv t � <br />` <br />Phonc/E�mail �.:� l��r, �„�+,-� . 1-•' 1d1�'� . ';�1 <br />ILDING PERMIT APPI.ICATION CONTRACT PRICE OP WORK j-SOO • T'� <! <br />Existing Use of Building �? � �� � <br />Proposed Use of Building � F�Z <br />2uilding type: `� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />OF WORK�addrtionalspaceprovidevonlheback�: <br />W�YV�G�G� <br />MECHANICAL PERMIT APPLICATION <br />01 ProJecl• __Now _Addn _Alteration _Rapair <br />Show Num6er (N) ol /ixfures <br />I A1C—airhandlinouni�s <br />heater <br />: <br />PLUMBING PERMIT <br />Use <br />TypoolProJoct: _New_Addn _Altoratlon_Repair <br />Show Numbcr (N) o! lixfures <br />Medical <br />Other: <br />ITI <br />NumberofHeads ! """'. <br />I hereby cenity t�at 1 hava reatl antl examined Ihis appli<aLon and know Ihe same to be tme anC cortect. All pmvisioaa ol lax5 enE ominences govem�ng t�is Iype ol wod wiil be mmp6eE <br />wAh whelhm specifietl herein or not. TTe granting e! a pertnil Eoo nol presume to gi�e aufiorrty 10 vioiate m cancel lhe Dmvislon ol any ot�er slale or local laH regulating wnsW p�on <br />T�at I am aulhorize0 by l�a oxner of this pmpertr to pedcrtn t�e work lot whlch appl'�wtion is made anE I comply wAh �he Slaie Conlractors Law 1B 27 RCW end ^.95 400A VJAC. <br />d <br />.e �, ., <br />� ; <br />�; � � '' , !�.- �� .:,�:�..,/���,� �_ <br />OwnerlAuthodzad Agent S�gnaluru Da�e jFevised 3/1073) � <br />