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PERMIT APPLICATIO <br />BUILDIN•VIECHANICAL / PLUMBING / SIG�RINKLER / DEMOLITION <br />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.qov/permits <br />CONTACT INFORMATION <br />ER NAME: �" �� J�-{,,� �g,� TENANT NAME (If Commerc <br />ER MAILING ADCiRESS: srReeT l'tf �i'�� % ��� "� ,�-�;� �y;,r�,t�� M' i.(,f <br />arr �� i rz� 1V �,�� �' � STATE <br />ER PHONE: -'��,� — :� ` �-- `�'" - , OWNER EMAIL; tii � <br />fR1tCTt'�R NAME: C,"�"i N.�_ �f'� J�'N�:� �L�..`��N �:� �`i1J "� <br />_.. i. <br />. <br />CONTRACTOR ADDRESS: srReeT I 7G• .,�'� %, i`�`ti .� �yt.{..(k r~ J�, fg <br />� � �L�l4- <br />CITY "'.+�1 �� � STATE <br />�ONTRACTOR PHONE: �' � " - ;;�.,�;� -- �;��/� GC)NTRA�1'i�FF EMAIL: ,,j�'_��t� {t'' t�t`#.'111.�'.�$Z <br />CONTRACTOR LICENSE #(REQUIRED); ��'����,�:�t�'���. '�. C,f'� CITY OF EVERETT BUSINESS LICENSE <br />RRIMARY CONTACT: ❑ OWNER C�''CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: �'�.� �,�}-��. CONTACT #��{iTNE: ��,�, -- �.� °� _ <br />� �..� `"`�c�"�.:�µ._. C�fr°J' °�...��...� CONTACT EMAIL: .� �����.' C �::�'�r°�rf�t:.t'' <br />ZIP �,��,;�<-�,�% <br />ZIP �,a'�{1 `-' �� <br />�"• ;�+�+�: . �C:��->�_. <br />�-- <br />UIREC?j: �.��y. � <br />��, �� ��., <br />� — BUILDING PERMIT APPLICATION <br />Existin se of 8uil in : r Contract Price of Work: $ ``� G' j i- �' �'` '" <br />Pro osed Use of Buildin : �r Heat Source: ❑Gas ❑Electric OOlh��r <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodei ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: /� � I <br />f�?U::.�`�.?� �L�-�'.•�ys.? � c.v� �r%hf%�'.§'i�L'�-t c:l�`2-°��Lt�<2 %�G�J�^' G�tl <br />� � <br />/`C � G�ccn.�^f- d'� JC►'lhti`q <br />� J <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMlT APPLICATION <br />Type of Project: New Addn Alteration _Repair <br />Fi tures List of Fixtures Fixtu es List of Fixtures <br />Toilet Backflow Preventer (Inside Bidg) <br />Bathtub Urinal <br />Lavato (Wash Basin) Drinkin Fauntain <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 ServicelBarlMo letc.} Other: <br />ACKNOWLEDGEMENT. 1 have reviewed this applrcation and confirm the information contained herein is frue and correct. Work done pursuant to fhis permit must comply with <br />current federal, state, and local law The granting of a permit only authorizes approved work and no deviations fhere(rom Deviations must (irst be authorized rn writing from the <br />Building Official before being aulhonzed unde� any circumstance. 1 am the owner, or / am authorized by lhe owner o( this property to perform the work for which application is made, <br />and ! comply wilh the Sfate Conlractors Law 18.27 RCW and 296.200A WAC ` <br />City of Everett 0/ficral llse Oniy <br />r+ � �' l <br />PERMIT <br />�"° ,%..=�.r= ,�;�'. ����-��.,- � �/ :�2j/ � <br />OwnerlAuthorized Agent Stgnature Date jiZeuisE>d Cu7 f}91a <br />