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PERMIT APPL"ICATION <br />BUILDINGIMECHAI4ICAUPLUMBfNG/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 />APPLICATIONS ARE ACCEPTEU FROM 8 AM TO � PM <br />lorrrewconstnxifon: Short <br />ft <br />PERMIT APPLICATION <br />No._ (aCech crop� af brq lega� <br />� L61LIc.ri L I� <br />�. q 3 P����zi s 2.5-7�� <br />ONTACT FOR PERMIT <br />To�N Mat-DoN <br />PFronelE•mali -' � <br />coN7w�CT PRICE OF WORK .�. , I <br />ngUseof6ullding tsrr• �iM1�rr��, r��i�-�rr.vc �.=-� ��r�� ����•��. <br />ised Use a( Building <�n��nM�-(�./�- Gas +� Electric._ Other_ <br />ng type; _ Single Family _ Duplex_Townhou e_ Mulll-Famlty �Commercial <br />of projact: _ New ,_ AddRfan _ Remodel �Repair_ T.I. _ Sign _Sprinkler _Oemolitlon_Change o1 Uu <br />ascriptlon of Work (adliitiorslape,.re providodon the beck): <br />Y'�:F'c.�"<�1P�.�1, E�':�.���� �:� P.If�,;v��l�� �r�, �URNAcE ���YH N�=v�i <br />you started working without a pertnit7 _YES �NO <br />CAL <br />af ProJect: _New� 4ddn _Alleration <br />CATION <br />_New�.ddn _Alleration_Repair <br />Other. <br />Gas <br />I hemby ceRifytliet I havu read atd emminod this appllcadon and kmwlhe sume to he true and cortect. AII provisione ollavrs ond ordirmnces goveminp <br />this lypa of xatkwill be complbd with xiwd�or specifiad horein or not Tha grantinp of a pertnR doas rol presume W 9Ne authorily to violace or mncal <br />tho pio��sion of atry other stato nr bwl low regulatlng co'nhuction orthe porformunce af co�ntnction. Thet 1 am authorized by tteo ovmer of Mis Pmperty <br />m porform tM work trn whkh apptic�jp\ n e mede and I mmpy with tha Stata Contractors Law 18.27 RCW and 298200 WAC <br />r 1� ��� �4t.A Ja:� �t C f� rY -':�t^^ i� i <br />Qwn IA17h�tizedAgentSiBnaWre Qata (Revisad7/20111 <br />J <br />eom <br />