Laserfiche WebLink
� PERMIT APPLICATIO <br />BUILDIIV�i MECHANICAL / PLUMBING / SIGN 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.gov/permits <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReer � � <br />CITI' STATE � ZIP (�O� <br />OWNER PHONE: � OWNER EMAIL: <br />CONTRACTOR NAME: \ � �� � � � <br />CONTRACTOR ADDRESS: sTReer ' � � <br />CITY � � STATE �'� ZIP <br />CONTRACTOR PHONE: — \ . CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: _ _ �� •s ' �.�Z <br />����� CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $�.,�� _�� <br />Proposed Use of Bu' ding: Heat Source: ' Gas ❑Electric ❑Other <br />Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition C`�Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�,\�"��� `y:�.. ���, ��i.� �v0�,���.� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration Repair <br /># of List of Fi�ctures # of List of Fixtures <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: 1 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 wwk and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the S{ate Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent <br />City of Everett Official Use Only <br />PERMIT # ' / � °') ^ <br />%L.� <br />(Revised 10/12/2015) � � <br />�� /� � / <br />