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PERMIT APPLICATIO� <br />BUILDIN�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@everettwa.gov � www.everettwa.gov/permits <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): f-N„�,,,1 � Crn- ( <br />OWNER MAILING ADDRESS: srReeT �a�w� <br />CITY STATE ZIP <br />OWNER PHONE: �OWNER EMAIL: <br />CONTRACTOR NAME: G �y ���6 J �.,,,� ,T,r-,�L <br />CONTRACTOR ADDRESS: sTReer �/t�/; L (/7� �Lu.L �' � <br />CI7`! ��(jr `/ ��.L STATE �y ZIP <br />CONTRACTOR PHONE: �(� ., �(a /� S�S�C. d CONTRACTOR EMAIL: ' 1�„ <br />� <br />CONTRACTOR LICENSE #(REQUIRED): � Gj'S ��L3 CITY OF EVERETT BUSINESS LICENSE #(REQUIF <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ��_� l..� S� � <br />��,� J� �y�,; � CONTACT EMAIL: � Gr�• Q�� w�L <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ <br />0 <br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: <br />�� ������ s��� <br />IASSOCIATED BUILDING PERMIT # (if aoolicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Fixtu es List of Fixtures Fixtures List of Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink 8� 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 is true 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 authorized in writing irom the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />'� City of Eve�eft Official Use Only <br />PERMIT # � � — � <br />(Revised 10/1?J2015) <br />