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P�RIViIi ,�F'PLIC,�T'10 <br />BUILDIN�iiECFi/aNIC�.L / PLl1�i1i �ING 1 SIG RIINFCLI�R / DEf�iOL.ITI(�N <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.everetfwa.gov/permifs <br />_. :_, . . _ , , <br />, <br />- PROJEC`I' SITE 1PIFQRMATIOId : - _ <br />_.. . <br />� _ . � ����� �+ z � �/ 3� � -7 2- f� � <br />PRO _ CT SITE ADDR 5� PROPERTY TAX #: f� <br />LEGAL for new construction: 5hort Plat/subdivision Lot No. (attach copy of long legal description) <br />_ _ - - <br />: _ - CONTACT IMFORMATIO.N <br />OWNER NAME: TENANT NAME (If Commercial}: <br />OWNER MAILING ADDRESS: sTR�� / � ' <br />GTY C_..,�I/�/�Q_� STATE ZIP L`—Y�� <br />OWNER PHONE• �OWNER EMAIL: _ <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: sTRee-r <br />CITY STATE Z�P <br />I,CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />�CONTRACTOR LICENSE # EQUIRED): ClTY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRlMARY CONTACT: OWNER `❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: c�7 -t ��" � <br />• �,.,� � � y �„ � CONTACT EMAIL: ��� � �� �� � • Cc�i <br />_ _ <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: �? S 1 " (` Contract Price of Work: $ <br />Proposed Use of B' ding: Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: SFR-Detached ❑SFR-Attached upiex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel � epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />r� la,� t��� l�e�,�e+� <br />ASSOCIATED BUILDING PERMIT #(if appiicable): L_ <br />__ . <br />PLUMBINC� PERMIT ,APPLICATION <br />Type of Project: _New _Addn _Alteration ' Repair <br /># of Lisf of Fixfures # of List of Fixtures <br />Fixtures Fixfures <br />Toilet Backflow Preventer (Inside Bfdg) <br />Bathfub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kifchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Wafer Heater Other: <br />Sink tService/BadMop/etc.) Ofher: <br />ACKlVOWLEDGEMENT: 1/iave reviewed this application and confirm the information contained herein is irue and correct. Work done pursuant to th�s permit musr compry wirn <br />currenf federal, state, and local law. The granting of a permrt only authorizes approved work and no deviations therefrom. Deviations musf first be authorized in writing frorn the <br />Building Official before bei authorized under any circumstance. I am the owner, or I am auihorized by the owner of this property to perform the work for which application is made, <br />and l comply with the S Contractor Law 98.27 RCW and 296.200A WAC. <br />Cify of Everett Officia! Use Only <br />, PERMIT # � <br />S - ~ <br />OwnerJAirthorized Agenf Sig ture te � (Revised 90/92/2015) <br />