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lue or Black Ink On <br />CT SITE ADDRESS: .� <br />for new construction: Short <br />OWNER NAME: '—�L �,L/� <br />OWNER MAILING ADDRESS: <br />ER PHONE: <br />TRACTOR NAME: � <br />TRACTOR ADDRESS: <br />� <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER ! 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 />�leasel PROJECT SITE INFORMATION <br />STREET <br />STREET <br />�PROPERTY TAX #: (�,�'j' <br />:�Lot No.,�(� (attach copy of long legal description) <br />CONTACT INFORMATION <br />' � � �NANT NAME (If Comme <br />� : <br />STATE <br />OWNER EMAIL: <br />cirr ��LLi'l2 �''7 <br />CONTRACTOR PHONE: i� r�"7 �'� l Ui�" <br />CONTRACTOR LICENSE #(REQUIRED): ��/��. <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR <br />ACT <br />� <br />STATE <br />CONTRACTOR EMAIL: � . �/ ��i <br />[a�>/��� CITY OF EVERETT BUSINESS LICENSE <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: i <br />CONTACT EMAIL: i <br />ZIP <br />ZIP <br />BUILDING PERMITAPPLICATION �--__-`" � � <br />xisting Use of Building: Contract Price of Work: $ C� ` <br />roposed Use of Buildin : —� Heat Source: ❑Gas 'OEle�tric ❑Other <br />uilding Type: - FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />ype of Project: ❑New ❑Addition ❑Remodel ��epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />ESCRIPTION OF WORK: . . � , • <br />� "�., <br />�e�?�� ir' -N2��G��vY) ��.� (�.�1`�1��'7e' ��� �J �� C�'I��ZL ��- {�L�G�i�ZC��' �ZL� <br />'' ����,�(,� C L' �` ` �- C�l l�� Y� v e`l' l G"1.��� !'��'� �C-lr2� <br />l I l � � %� ./`2 � � � J <br />SSOCIATED BUILDIN6 PERMIT # (if applicable). <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration Repair <br /># of List of Fixtures # of List of Fixiures <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 fo 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. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply wifh the Sfate Contractors Lp w 18.27 RCW and 296.200A WAC. <br />Agent <br />City of Everett Official Use Only <br />PER IT <br />1 ^ � <br />(Revised 5/20/2016) <br />�� <br />