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PERN1IT AP�'LiCATION <br />B�ILDING/MECHANICaL/PLUMBiNGISIGN/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 />ESS: � <br />/Q � <br />lar new cor.sfruc�ion: Short <br />anrtixa <br />No <br />T# <br />(al�ach copy ol lang legal description) <br />NT:,�Owner _OwnelsAgent _CoMractor _ConlractorsAgenl _Tenanitm�vommceama�ro�mns�r.rcomuso»r�rme�wea�nmoi;,s1 <br />BUILDING PERM7T APPLICAT60Pi <br />Lic. # .�rorc% KR <br />NTRACT PRICE OF WORK <br />ng Use of Bwlding N/p <br />�sed Use of Bwlding t,��_ Gas <br />ng type: � Single Family _ Duplex _Townhouse _ Mulli-Family _ Commercial <br />of pro�ecC � Ne�.v Addilion Remodel Repair _ T.L _ Sign _Sprinkler _De <br />�RIPTION OF WORK /aCd�rional space provided on fhe backl � <br />fFQ /y'OZ SF -hia. � <br />��%� f� - � �Q� <br />MECHqNICAL PERMIT APPLI�ATION <br />ol Project: �,New _Addn _Altoration _Ropair <br />Show Numbrr (d) ollixfures <br />A�C — air handling uNts <br />Gas <br />Heat <br />Woodstove <br />m <br />Bus Lic. K <br />HEATSOURCE <br />of Use <br />PLUMiiIkG PERMIT APPIICATION <br />olProject: _New_Adtln _Allcration_Ropair <br />Show Number (H) ol lisfares <br />� � Toilet <br />1 I Balhtub <br />washer <br />Roof drains <br />Medical Gas <br />Other. <br />Other: <br />I nereby cenAy inal I nave rea0 antl eraminetl Ihls applicalion ana know t�e same to Ee Ime a�d coneoL All vmvision, al laws ond orEinance; goveming i�a type of wo�k w� I �e comphed <br />wiln xnetner specifeC rein or noi. ihe 9ranting ol � pertn.^, 7ves net presume io gn�e aut�onty lo v�oiaie or wncel ��e p:orision o/ an� eTer sta�e or local laN regula�ing mnswq�an <br />IDai I am amnorizeC D i�e owner ol ims D�� y lo petlorm tne wo�k fo� w�ich aPP:��a!ion is ma0e an0 � comply wiih ihe Slaie Cemrae.ois Law 78 27 RCW antl ]56 200A W?.C. � <br />� � <br />q /o i 3 <br />OwnedAulhorizod Agent Signaturo Dale (Revised,7/2073) <br />