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PERMIT APPLICATION <br />BUILDINC�IECHANICAL / PLUMBING / SIGN�RINKLER / DEMOLITION <br />CiTY OF EVERE7T PERMIT SERVICE <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � vuww.everettwa.gov/permits <br />Blue or Black Ink Onlv P <br />SITE ADDRESS: <br />PROJECT SITE INFORMATION <br />PROPERTY TAX #:OO�6Sl � t I C'J�oZ�O <br />for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: p S� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReer .�6OS I lo� � <br />CITY V� STATE ZIP <br />OWNER PHONE: -� -- OjBs OWNER EMAIL: O H?QS li,.�. D G� l Q�lOO � Cli�'Y/ <br />CONTRACTOR NAME; (����/�] $ ���[/�tq /}� Q�'tp �Q�/✓! <br />CONTRACTOR ADDRESS: srReer % � gdpZ �'` � ,st <br />CITY �V tiYL STATE �¢Q , ZiP 8j?O (J- <br />CONTRACTOR PHONE: o?G�- yj� - p�q� I� CONTRACTOR EMAIL: ,L� KI A✓J m OSK �I't C C�mC�S� ^�� <br />CONTRACTOR LICENSE #(REQUIRED): �1?)A� �NB�I %G'%� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): %� � <br />PRIMARY CONTACT: ❑ OWNER L9'�NTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �a6 . 6l� 7_ a a� g <br />��� ��� �NS CONTACT EMAIL: �J�N o OSI�i1Y7S@ COh'/CQS� �°-D� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: kE�., ,,t�r �� % S�i� Contract Price of Work: $ � <br />Proposed Use of Buiiding: �5� _-1117��/ S%"�i2 Heat Source: Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />T pe of Project: ❑New ❑Addition ❑Remodel 'C��e air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: � r <br />��✓✓1C�'Vz` Q✓�L,� t'��Jl�' G%`� S rI?C1G�, c'�: �% C�OLJYZ i���a-.� , <br />/ � <br />ASSOCIATED BUILDING PERMIT #(if a plicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New Addn Alteration Repair <br /># of Lisf of Fixtures # of List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bid ) <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/BarlMop/etc. Other: <br />ACKNOWLEDGEMENT: I have reviewed this applicafion and confirm the information contained herein is true and correct. Work done pursuanf 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. Deviafions must first be authorized in writing from the <br />Building O�cial before berng authorized under any circumstance. 1 am the owner, or! am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent <br />City of Everett O�cial Use Only <br />._ / j PERMIT # � 1 � �^ — ; � � <br />l/ I <br />Date (Revised 5/20/2016) <br />