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PERMIT APPLICATION <br />BUILDINC ECHANICAL / PLUMBING / SIGN 'RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVIG�� <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 />ADDRESS: ,1G' S/�-'r�. ��1���^r- t.'c L( PROPERTY TAX #: C%t-'�",� �a Z L"�'C.'C' �. .y �%C7 <br />IILEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br />I BUILDING PERMIT APPLICATION � <br />Existing Use of Building: �'yC,�r �t� ��r.�� �- ��,� <br />Proposed Use of Building: �1��;.c.r2_ <br />Building Type: ❑SFR-Detached ❑SFR-Attached <br />Type of Project: ❑New ❑Addition Remodel <br />DESCRIPTION OF WORK: <br />'S(y �Contract Price of Work: $ %f; �'L�C� <br />�Heat Source: �! <br />❑Duplex ❑Multi-Family-# of Un <br />❑Repair ❑T.I. ❑Siqn ❑Spri <br />s ❑Electric ❑Other <br />�Commercial ❑Industrial <br />er ❑Demolition ❑Chanqe of Use <br />�,�rl��t.�Gf� G��.'S�: ✓� ��,�; z:.t, � �r.c:�t o/ G+-c"t�7t�" L % /`�Y��:� �7 fcr�a� �4 .�� I�-� /�i`e �e�r_S � �i �• �t Fid� <br />L`u- �G t' L•�GTG'' t'' .' • <br />�ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Afteration _Repair <br /># of List of Fixtures # 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: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />cu��ent federal, state, and /ocal law. The granting of a pe�mit on/y authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing f�om the <br />Building Official before being authorized under any circumstance. I am the owner, or I am autho�ized by the owner of this property to perform the work for which app/ication is made, <br />and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />��-t ,����e c��.� <br />Owner/Authorized Agent Signature <br />(l�. ���vY /`Y�: lc � C•' �i-Z �j - ��i.'l� • �/4 C � <br />Date ���-���� <br />City of Everett OHicial Use Only <br />PERMIT # <br />P ( �D `E ��- o (� <br />(Revised 10/12/2015) � <br />7i <br />