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RY <br />PERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLER/D�MOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar Sl., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPLICATIONS ARE ACCEPTEO FROM B AM TO 4 PM <br />ADDRESS; , �'' , - PftOPERTVTA%p P�il�n � �O� <br />. for new wnslmclion� Shon PlaVsu�Oivision Lot No. (attach wpy ol Iong legal desrnplion) <br />R . � '. PhonclE�rtuil �.t:;- � <br />- . � ' Ci�ylSlatMLp � '�. .. . . . . , . <br />;ANT: Owner _OwnefsAgent � . Conlractor CONraclofsAgeM Tenanllm+sipmvaoak�crotrcme�ahvmmoc.+�eruao�wv�w�na.oecax) <br />tACTOR ; � � � "l ;�. ; � L & I Lic. #. ' : �; � . ' � � � COE Bus. Lic. # <br />- _ � i <br />..- , . . _ . . . _ , . . Phone/Email , _ ... . <br />PERMIT ApPLICATION <br />PRICE OF WORK <br />Use of Building I <br />d Use of Building C <br />type: j_ Single Famity _ Duplex _Townhouse __ Svlulti-Famiiy _ Commercial <br />aroiect: New Addrtion .'� Remodel Reoair Tl Slan Sormkle. <br />HFJiT SOURCE: <br />ESCRIPTION OF WORK (adoi�ionai space pmvitletl on �he back): - . <br />, �....:� �=�7--•. , . _. .. _. .. . ' _ ,.i:� .�. , �.. .. , <br />,i :� <br />5;.p���`e �(uho Permi7 <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />pe ot Pro;ect: _New _Adtln _Alterallon _Nepalr 7ype ol Projecl: _New _Addn _Alteratlon _Repalr <br />Shaw Number (p) ol firfures S�ow Num6a !a) ol lixtures <br />i <br />Other <br />Olher. <br />Gas <br />I here0y certTy Nal l �ave rea0 anO e�aminN Nu nppication anE kno.v Na same lo Oo Wa and coned. M pmvisione ol W�n anE ortlmances Ooveming Ihu rype o1woA m0 bo mmp�e0 <br />wM w9ei�er spea;rd �erein or not The pantinp o( a permil Eom nol pmsume ta prve au+homy lo Nclate or uincel No pm�ision ol any oNa SLite o� local hw regulaling constmclion <br />T�al l am auNoneeC bY Nc owner ol N�a prpDeM �n Pertam IAa woM /w whkr appOcalion ie matle an01 compy wih Ihe $�ale Contmnan Lew 1B.I7 HCW entl 298.200A WAC. <br />OwncriAuthorize\agent Signature Date <br />� _/ <br />(Revised N2017) <br />`f � <br />