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PERMIT APPLICATIO�' <br />BUILDINU 1 MECHANICAL / PLUMBING / SIGN � JI 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 />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: PROPERTY TAX #: <br />- .� . � � — �'1 <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ' TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREer <br />CITY STATE ' ZIP <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): •. � 1� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER L9�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: — 7��'` <br />l����a CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ �. <br />Proposed Use of Building: Heat Source: L�7Gas ❑Electric ❑Other <br />Building Type: C�SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Pro'ect: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />`h`�,� �7,5�,�.. ��;t�...`7 ��`,►�,�'C'U: �1 \�"�,\-��r <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fi�ctures <br />Fixiures 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 />Ciothes 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 he�ein is true and correct. Work done pursuant fo this permit must comp/y 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. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and I comply wSith the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� City of Everett Official Use Only <br />�,;� �.,-_-- � / --._ <br />; ,� <br />� ,� � ,��% ;- _ <br />Date <br />PERMIT # <br />v � � - � ������ <br />(Revised 1 H?J20 5) � <br />�3�,�-� <br />