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PERMIT APPLICATIO� <br />BUILDIN� MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />Ev CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />f1 IFCT CITF AIl1�DCCC• . oonocoTv Tnv �. <br />for new construction: �Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER NAME: ���,3,,v1 �� �V� <br />OWNER MAILING ADDRESS: srReer <br />OWNER PHONE: ��,�'(,� — <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: <br />CONTACT INFORMATION <br />�-� � TENANT NAME (If <br />-li,l ��,� � e., <br />cirv � J�..`E <br />� — ���� <br />STREET <br />CITY <br />CONTRACTOR PHONE: <br />CONTRACTOR LICENSE #(REG2UIRED): <br />PRIMARY CONTACT: �(OWNER ❑ CONTRACTOR <br />CONTACT NAME: <br />��e,� �@ c��-`, � <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached ❑SFR-Attache <br />Type of Project: ❑New ❑Addition ❑Remodel <br />DESCRIPTION OF WORK: <br />�, r'e � �L.i "1 `'` <br />�'�"Gi.-�._✓V'C ��C—W�, j . <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />� cr <br />STATE W <br />OWN ER EMAI L: �� �.I^,i /9 �, I✓►n � <br />STATE <br />CONTRACTOR EMAIL: <br />CITY OF EVERETT BUSINESS LICENSE <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: Q, <br />CONTACT EMAIL: t_�� , <br />0 <br />BUILDING PERMIT APPLICATION <br />Contract Price of Work: $ <br />Heat Source: ❑Gas ❑Electric ❑Other <br />d ❑Duplex �Multi-Family-# of Units: ❑Commercial <br />❑Repair ❑T.I. ❑Sipn ❑Sprinkler �emolition ❑Chanc <br />a5�'V\ -,� �'�L� C'� ��j�—., �G.U"►'1�C.k�J <br />ZIP <br />ZIP <br />�� <br />❑ Industrial <br />� of Use <br />U <br />� <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New _Addn Alteration Repair <br /># of Lisi of Fixtures # of List of Fi�ctures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing irom the <br />Building Official before being authorized under any circumstance. l am the owner, or I am authorized by the owner of this property to pertorm the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Rufhorized Aaent Sianature na <br />City of Everett Official Use Only <br />PERMIT #� � � � <br />� <br />(Revi d 1 /12/2015) <br />��"•f 1// <br />�l ✓ , ! <br />