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PERMIT APPLICATIO <br />BUILDIN(�IECHANICAL / 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 />^� PROJECT SITE INFORMATION <br />OJECT SITE GDDR�SS: kBlo C�! l. W.g,� PROPERTY TAX #: Z� ��l �E��O � 5'0� <br />_� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: {�..�(,�Q�p�,/' —���/� ��,� S TENANT NAME (If Commercial): ����� t <br />OWNER MAILING ADDRESS: srReer c,In ��/ PJ/� .L�,t�_ _ F��I L�NrnN �T. � 5��� <br />OWNER PHONE: <br />CONTRACTOR NAME: -�; <br />CONTRACTOR ADDRESS: <br />cirv <br />STREET <br />CIiY I� <br />CONTRACTOR PHONE: j�� <br />CONTRACTOR LICENSE #(REQUIRE <br />PRIMARY CONTACT: ❑ OWNER <br />�+i11�: _ <br />�-- � i�/C=��- �k <br />�� <br />Bui <br />�g Use of Bui�ding: V1/�, � � o�v��� <br />�sed Use of Building: 9�-l. � <br />ng Type: ❑SFR-Detached ❑SFR-Attache <br />of Project: ❑New ❑Addition �model <br />;RIPTION OF WORK: _J �L�� <br />IASSOCIATED BUILDING PERMIT # (if applicable): <br />STATE <br />OWNER EMAIL: <br />� <br />pyI ��r/i STATE <br />CONTRACTOR EMAIL: ��tc� �a ex <br />�(_ (� CITY OF EVERETT BUSINESS LICENSE <br />)R ❑ OTHER (Please Specify) <br />C4AITACT PH[3NE: ��� �j Z� l 7 <br />T EMAIL: F.%�. o � �., ,. ,�I ;-: �, <br />B4fL�ING PERMIT APPLICATION <br />'T' Contract Price of Work: $ I�S : o� <br />Heat Source: ❑Gas ❑Electric ❑Other <br />d ODuplex ❑Multi-Family-# of Units: �mmercial ❑Industrial <br />❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br />s ��� � � ��.� �.�� <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn Alteration _Repair <br />Fi tu es List of Fixtures Flxfu es Lisi of Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinkin Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: �n.� <br />Sink (Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is irue 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 work and no deviations therefrom. Deviations must first be auihorized in writing from the <br />Buildrng O�cial before berng authorized under any circumstance. ! am the owner, or ! am authorized by the owner of this property to perform the work for which applrcatron is made, <br />and l comply with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Evereit O�cial Use Only <br />' z� PERMIT # <br />��%� Z.��zo/� I (0 ' � �. <br />Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />