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� PERiVili APPL.IGATIOY'.
<br />�UILDING I f�tECHARIICAL 1 PLUMBIiVG / SIGN I��PRINKLER / DEfViOL.ITION
<br />CiTY OF EVERETT PERMI7 SERVICES
<br />� 3200 CEDAR STREET, EVERETT, WA 982�1
<br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits
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<br />:, ,,: :: :;; : .-..non'�Gr�r_c�4G �n11FARM�T`IaN .. :. .
<br />LEGAL for new construction: 5hort Plat/subdivision� Lot No. (attach copy of long legal description)
<br />OWNERNAME: ;`jt7� \r���v�
<br />OWNER MAILING ADDRESS: srREe-r
<br />ci7v
<br />OWNER PHONE: �{ZS � � �'�i " ��
<br />CONTRACTOR NAME: ��o.�� � ��
<br />CONTRACTOR ADDRESS: srReer ��
<br />cirr L'�{i;`
<br />TENANT NAME (If Commercial): �.v
<br />OWNER EMAIL:
<br />�i e;S�-�,G�:�
<br />1/ l 61�i
<br />STATE
<br />STATE �l: i�
<br />C�NTRACTOR PHONE: CONTRACTOR EMAIL: �.av � �;
<br />CONTRACTOR LICENSE #(REQUIRED): j`"'�,�J �ZC �- " `��;G CITY OF EVERETT BUSINESS LICENSE
<br />.... .,,. .,,_.... , :.,, :...,...,..,..,.....,. ...., ..,., .� ...,._.... .......:,,. ._., ... ,. ..., . ..
<br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify)
<br />CONTACT NAME: E� Z� � l' `�,� ��� CONTACT PHONE: � Z� _ L( (G(— (�
<br />�;"�j� Cjt�'v�-i.ti''L"� CONTACT EMAIL:
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<br />ZIP
<br />ZIP { �'��7Z
<br />� 1 1'
<br />IRED):
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<br />_- � ; .: . _ BUlLD1.NG..PERMIT �APPLICATION ::
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<br />xisting Use of Buiidmg: Contract Price of Work: $ ����� C>e
<br />,.,
<br />_:
<br />roposed Use of Building:
<br />Heat Source: ❑Gas lectric ❑Other !:::�
<br />uiiding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex I�Multi-Family�# of Units:�_ ❑Commercial ❑Inc�
<br />ype of Project� ❑New ❑Addition ❑Remodel �1Repair ❑T I ❑Sign ❑Sprinkler ❑Demolition `=::��hr`�n�e:of Us�
<br />_ �
<br />ESCRIPTIONtOF WORK: `:':"
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<br />ILC, �`✓ �u'�'e, i�NLri l�. c� � b�r�.�l+�w p (� ��ta5�t-. !:;';
<br />r" `� � :::a
<br />-�, S ; ��� ,F�V�� c�-i. `n�,�°�. ��� C�;a,L- _,..
<br />SSOCIATED BUILDING PERMIT # (if applicable): _
<br />;. : PLU;MBING PERIUIIT /
<br />Type of Project: New _,Addn
<br /># of List of Fixtures Fixtures
<br />Fixtures
<br />Toilet
<br />L
<br />Disposal
<br />eater
<br />:�.::; i'��i
<br />'�}'
<br />: , : ..:
<br />,_ ;±::�:�
<br />PP[�ICATION_: !-
<br />,,;^. Al�eration Repair �= �
<br />„ ; , ���st of Fixtures _
<br />Ba�icflow'P eventer,-(I:nSid� `Bldg)
<br />Urinal . -�:'� � ,�
<br />Drinking Fountain ��' - `
<br />Floar Drain
<br />Grease Trap
<br />Roof Drains
<br />Medical Gas
<br />Other:
<br />ACKNOWLEDGEMENT.• ! 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 /ocaf law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must firsf be autirorized in w�iting from the
<br />Building Official befo�e being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property fo perform the work for which application is made,
<br />and / comp/y with ihe State Cont�actors Law 98.27 RCW and 296.20oA WAC.
<br />City of Evereti Officia! Use Only
<br />`� � � � I � I � � PERMIT # ��� ( lf/ V �� LJ .'�j .
<br />O -orized Agent Signature Date (Revised 90/9212015)
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