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• PERMIT APPLICATIO� <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�a?everettwa gov � www,everettwa.gov/permits <br />( BUILpING PERMIT APPLICATION � <br />ExistinU Use of Buildinq: �i'Y,o(o — <br />Proposed Use of Building: �yr�ki <br />Building Type: Cf�FR-Detached ❑SFR-Attached ❑Du <br />Type of Project: ❑New ❑Additian ❑Remodel C�ep� <br />DESCRIPTION OF WORK: <br />Contract Price of Work <br />Heat Source: ❑Gas <br />❑Multi-Family-# of Units: <br />❑T.I. ❑Siqn OSprinkler <br />`1��►rn we �r�.�c,�'fi�► v � (� c� w� �"r"�' � B�-, . <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />.• <br />❑Electric ❑Other <br />❑Commercial ❑Industrial <br />❑Demolition ❑Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of ProJect: New Addn Alteration _Repair <br /># of Lisi of F/xtures # of List of Fixtures <br />Fixfures Fixtures <br />Toilet Backflow Preventer (Inside Bld ) <br />Bathtub Urinal <br />Lavato (Wash Basin) Drinkin Fountain <br />Shower �1oor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/BarlMop/etc.J Other. <br />ACKNOWLEdGEMENT: I have reviewed lhis appfication and confirm the information confained he�ein rs true and correct. Work done pursuant fo this permit must comply with <br />currenl lederal, state, and local law. The qrantrng of a permit only aulhorizos approved work and no deviafions therefrom Deviations must firsf be authorized rn wrifing irom the <br />Buifdmg Officraf before being authorized under any circumstance ! am the owner, or 1 am authonzed by the owner of this property to perform fhe work for whrch applicafion is made, <br />and 1 compfy with Ihe State Contraclors Law 18 27 RCW and 296 Z00l1 WAC <br />0 <br />�� <br />Agent Signature <br />City of Everen Officia! Use Only <br />20/(p PE IT ��iJ � O f �� 3 <br />(R�a�ls�ti 5i1Lt�f�lfi) <br />