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- ---� P�F�il�ll" ,4F'PLICA7"IOt� <br />�U9LD1� �il�C��,i�1G,41� / F'l�lJ�li�ING / S1G�SI�RIi��CL�P� / L��fVlO�li"ION <br />� CITY OF �VERETT PERMIT SER � <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 I FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑5FR-Detached ❑SFR-Attached <br />Type of Project: ❑New ❑Addition ❑Remodel <br />DESCRIPTION OF WORK: <br />BUILDING <br />Contract Price of Work: $ BO <br />HeatSource: ❑Gas ❑Electric <br />❑Dupiex ❑Multi-Family-# of Units: <br />❑Reqair ❑T.I. ❑Sian ❑Sprinkler ❑Demoliti <br />1iG�� �i C�a4'�a�` �E.►�cc/' <br />OCIATED BUILDING PERMIT # (ifi applicable): �j � �11�-��j� <br />❑Other <br />,�Commercial ❑Industrial <br />on ❑Chanqe of Use <br />PLUMBING PERMIT APPLICATION ` <br />Type of Project: ,_New _Addn _Alteration _Repair <br /># of Lisf of Fi�ctures #°f List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathfub 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.- l have reviewed this application and confirm the info�nation contained herein rs true and correct. work done pursuant to tnis perm�t must compry wun <br />currenf federal, stafe, and local law. 7he granting of a permit only authorizes approved tvork and no deviations therefrom. Deviations must first be authonzed in writing from the <br />Building Official before being authorized under any circumsfance. I am fl2e owner, or I am authonzed by the owner of this prope�ty to perform the work for which application is made, <br />and / comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br />� <br />Owner//Authorized Age�plF Signature <br />� <br />Cify of Everett Official Use Only <br />PERMIT# <br />� b 'D <br />(Revised 90/92/?095) <br />