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� <br />� <br />� <br />PERMIT APPLICATION <br />BUILDING :CHANICAL / PLUMBING / SIGN /�� 31NKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 ! FAX 425-257-8857 1(E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJ CT �ITE ADDRES : PROPERTY TAX #: <br />��� {'" P ,��� � �;-,� � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description} <br />CONTACT INFORMATION <br />OWNER NAME: v���- �i�,Gr,1eL�,� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTaEFr � L7'=j ((v tL � f' <br />CffY �"� f-�- STATE � ZIP J�Z L7 <br />OWNER PHONE: � ,� - �j ��j -�/��(, OWNER EMAIL: j� �i�l��'t� �� "iy7eti I, (cY»1 <br />CONTRACTOR NAME: ' � �q�T � � Z�': LLC'-- <br />CONTRACTOR ADDRESS: sraEEr U Z��, / /( <br />CITY j��1�� �� STATE �- ZIP �� � � � � <br />1 <br />CONTRACTOR PHONE: � � `j - ^'�/ - �?�'�� CONTRACTOR EMAIL: %� ,, y� > c��1� �y j.�;� � �,;.�-, � <br />CONTRACTOR LICENSE #(REQUIRED): � - ) 4��j'�? CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): (} `�� �� <br />PRIMARY CONTACT: O OWNER � CONTRACTOR O OTHER (Please Specify) _ <br />CONTACTN E: CONTACTPHONE: Z;� '31�3._ (,f�,�j� <br />, <br />J ��jr }� �!'-�?��[�;� CONTACT EMAIL: j �`� . <br />f'i✓,� � dCt��K � .i 7.d' - �'. <br />BUILDING PERMIT APPLICATI N <br />�xi,stin Use of Buildii� : �r�... �o�.#rae� ¢�ric�e oP W�ork: � - � ���� <br />Proposed Use of Buildin : jj- .— Heat Source: O Gas 0 Electric 0 Other <br />Buildin T pe. SFR-Detache� 0 SFR-Attached O Duplex O P�tutti-Family-# of Unsts�. O Commerclal O 4ndustrial <br />Type of Project: 0 New 0 Addition { Remodel 0 Repair O T.I. O Si n 0 Sprinkler O Demolition O Chan e of Use <br />I]ES�CRtPTFOi�t OF W�?RK: ,,LL'' '' `I.--��,I � <br />j�Q�UL' (��� ��'�lr�/ `�` � ,� 1vi� L'4nr,�,��' �Tk �� ��Ir ��.0 ,�v< <',rc1�r <br />/ ✓ <br />?-�, i't'(i't �c' �ZGnh �i�✓ ��c.�� �' � r-ih+n (�.7 ,h,`ny �5 .. <br />ASSOCIATED BUILDING PERMIT #(if a licable : <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _ New __Addn Alteration _._Repair <br /># of List of Fixtures #�f List of Fixtures <br />Fixtures Fixtures <br />Toif�t Backf4ow Preventer (Inside Blci ) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Fioor 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: 1 have reviewed this application and confirm the information contained herein rs true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granting ot a permit only authorizes approved work and no deviations therefrom. Deviations must �irst be authorized in writing from the <br />Building Official before beinq authorized under any circumstance. l am the owner, or I am authorized bV the owner of this propertV �o perform the work for which application is made, <br />and I compty with the State Contractors Law 18.27 RCVV and 29ti2u0A WAC. <br />City of Everett Official Use Only <br />PERMtT �ib � <br />i� --_ n ��� � <br />(Revised 10/12/2015) <br />