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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES 5 - -&q <br />3200 Cedar St, Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROPERTY 7A%R RM�I vJ <br />SITE ADDRESS' 1 a � os <br />- <br />r)L 3 2 -TTI Ay( bUFS'r ESP f P fi <br />Inr11nn/e//w construction. Short PlaVsu bdivision <br />Lot No <br />_ (attach copy long legal desorption) <br />2 F'�r Krusip _ <br />Phone,E.. <br />1of <br />e-a rao Dull I,� <br />Ca` - <br />rni Vle C. rULl <br />U . apx 12 0 (� S <br />ACTOR -Ii �Lt �.S(7� f: AL,`l F' V� ,)JC. <br />GtYlSlale1z,, <br />L81Lic.M <br />-r v, fl l I �1LAj A <br />Nr)i=Cc rtT�r75 �� <br />I/fit' ci .? G'?) h JS11 i;! ,l'1` UA �f't0d <br />-� <br />Phone/Email 2 - ddot <br />T BUSINESS NAME t <br />1y1(�F �1Gil6BPS I �en i <br />CONTACT FOR PERMIT <br />Phone/E-mail �- <br />V.1 S FAG: y S'1�0 <br />DING PERMIT APPLICATION <br />CONTRACT PRI.:E OF WORK <br />IM ! I HEAT SOURCE: R <br />ding Use of Building <br />posed Use of Building ti� ` Gas ElectrK Other Q1 <br />Idinq type: —Duplex _Townhouse _ Multi -Family _Commercial <br />ie of project: _ New _ _ Addition _ Remodel _ Repair _ T.;. _ Sign _Sprinkler _Demolition_Change of Use <br />:eription of Work (additional space provided on the back): <br />...rr..11 <br />Jr <br />we you started working without a permit? _YES NO <br />MECHANICAL PERMIT APPLICATION i PLUMBING OERMIT APPLICATION <br />of Project: _New_Addn —_Alteration _Repair <br />Heat <br />( <br />of <br />of Project: _New_Addn _A%eration _Repair <br />LIMIM <br />Medical Gas <br />Other <br />I hereby certify that I have mad and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing <br />this type of work will be complied with whether specified herein or not The granting of a pe"il does not presume to give aulhority to violate or cancel <br />the provision of any other stale or local law regulating construction Or the performance of construction. That 1 am authorized by the owner of this properly <br />topflorm the work for whi pplication is made and I comply with the Slate Cnnlractors Law 18 27 RCW and 296.200 WAC <br />', 0/�11 L. - �l�- <br />_ _ (Revised 2120I1) <br />