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� <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES �I �� �� <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROIN 8 AM TO 4 PM <br />ADDRESS: � PROPERTYTAXp PE ��(�'J�O�d <br />7/ ��LCG/Y �.�4i C[/C�ZG� <br />\L (or new conslruclion: Shorl PlaVsubdivislon Lol No._ (allach copy of �ong legal de;criplion) <br />!7D <br />LDING PERMIT APPLICAYION <br />Exisling Use of Building <br />PhonelE-mall <br />CitylStalelZip <br />L&ILic.# <br />�Q61/ PhanelEmail %(d. 52Z.%By0 <br />CONTACT FOR PERMIT �� p, y l j, 78Ya <br />SwT <br />PhonelE-mail �Gp� �.y��s< i��� <br />CONTRACT PRICE OF WORK <br />�sed Use of Building — <br />ng type: _ Single Family _ Duplex _Townhouse _ Mulli-Family Commercial <br />oi project: __ New ,Addilion _ Remodel _ Repair ✓T.I. _ Sign _Sprinkler_�emolilion_Change of Use <br />'iplion of Won: (uddif'ona� spaco provided on tho back): � � / /J �/ <br />� G���LL lJ 7 � �i <br />you started working without a perrnit? _YES tlNO <br />MECHANICAL PERMIT AP'OL[CATION <br />ofProJecl: _New_Addn _Altcratian_Repalr <br />shnwNum6cr!#)o/(ixtures _ <br />P�.UN7BING PERMIT APPLICATION <br />ofProJe;!: _Now_Addn _Allerallon_Rapalr <br />Medical Gas <br />Other: <br />I� Numher of Heads � """' <br />I hereby cerlify that I have read and examined Ihis application and kno�v Ihe sama I� bo trua and coRecL All pwvisions of laws and odi�ances goveming <br />this lype of work will be complied wilh whelher specified hereln ar not. The �renling o( a permit does not presume lo give authorily lo violala or cancel <br />lhe provislon ol any other slale or local law regulating conslruction or Ihe performance of conslru;.tion. Thal I am authorized 6y lhe awner ot lhis pr.peAy <br />to peAor�ry��e work for which applicallon fs m3do and I comply wilh Ihe Slate Coniractors Law 1 B.'_7 RCW and 296.200 WA' <br />f //,/p( / \/ %//i�/ <br />O nerlAulhorizad Agenl Slgnaluro <br />Oale (Pevised 2/201 f) <br />{ <br />V <br />