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Sep 26 16 12:54p <br />� p.2 <br />PERlIII1T APPLICATI� <br />6UlLDtNG ! MECHANICAL I PLUMBING 1 SIGN / SPRINKLER / DEMOLITI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREi-T, WA 9820� <br />(P) 425-257-8810 ( FA3{ 425-257-8857 C(E} everetteps@everettwa.gov � www.everettvra.gov/permits <br />(Blue or Black Ink Only Pleas ) PROJECT SITE INFORMATIaN <br />PROJECT SlTE ADDRESS: l,�- r�'��i 4 G� � C� � G� �� • P�flQERTY TAX #: <br />LEGAL fior new constructian: Short Platlsubdlvision Lot No. (attach copy of long legal des�ription) <br />CONTACT iNFORMATION <br />OWNER NAME• C� y -� -{��j'1 (' i-��jr TENANT NAME (If Commercial): <br />r p l j�—,/ <br />OWNE}2 MAlLING AUDRESS- srneeT 1��' ���i{''_. �G 1 I�i�- �=� � <br />CI7Y (i:��•� STATF J� 21P � : � <br />OWI�ER PHONE: `-i"a-5 " �� ��� - � � � `t' OWNER EMAIL: — <br />COPITRACTOR NAME: �' } r"r��.��?' (�>�"Y-'� ` I <br />CONTRACTOR ADDRESS; s�ue�r L-}-� I� <br />-}— j �- 1� <br />� ` �-� - 4"�-l1 <br />�'�� � ��' � " GL <br />CITV STATE <br />ViRACTOR PHONE: CONTRACTOR EMAIL: �� �;���j,- t�'LLI�L <br />VTRACTOR UCENSE #(REQUIRED}: j.'1L 1��(�.� S�'�G'1�� ���'' CITY OF EVERETT SUSINESS IJCENSE <br />MARY CONTACT: ❑ OWNER �ONTRACTOR ❑ OTHER (Please Specify) <br />4TACT NAW1E: �;�L7 L� ������ ��%� C4NTACT PHaNE:,,I� i7 _3���-�—� <br />CONTACT EMAIL: ,.-� � }rL� S `�'L 6'�Z �1l�1 <br />Bl31LDING PERMIT APPLICATi�N <br />Z7P �� _ <br />vt� %�ti�CC�� t�� <br />EQUIRED):�i� �'� <br />ing Use of Building: Contract Prlce of Work: $_ SS �� 1•�� <br />osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br />ling Type• E�&FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial �lndustrial <br />� of Pro}ect: ❑New ❑Addition C3Remodel ORepair OT_I_ ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br />CRIP7101u OF WaFiK� �� i l.i�� �(�{ ��s� � I��� Y'L� I`Z�f /J <br />IASSOCIATED BUILDING PERMIT # (if applicablel: <br />PLUMBlNG PERMIT APPLICATION <br />Type of Project: New Addn Alteration _Repair <br />Flxiures Llst ofFixfures Fpxtures List ofFixtures <br />Toilet BackFlow Preventer (1nsE� <br />Shower <br />Kitchen Sink & <br />Dishwasher <br />Sink <br />Heater <br />Urinal <br />Basin) Drinking Fountain <br />Floor Drain <br />lisposal Grease Trap <br />Roo3 Drains <br />Medicaf Gas <br />Qther <br />ir/Niooletc.l Other. <br />AGKNOWLEDGEh9ENT: 1 have reviewed this application and conGrm the infarmaUon conhained herern is true and correcl. Work clone pursuant fo this permit m��st comply wifh <br />current federal, stato, and loct�l law. The granting of a permil onfy authonres approved work and no deviations therefrom. Oeviations must ftrs[ be auiho�zed in writiny Irom the <br />t3�adtnq official belnre being authonzed urtder any crrcumstanc�. ! am the owne� or ! am authorized by the owner of fhis praperty fo perforrn the woric for which applicafion is made, <br />and I comply w8h the Stafe Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Evereft O�cial Use OrrJy <br />C� ;' ��.. � �-� � � � P�� �. C� 0� ~ O`�- Co <br />dxmerlAuthorized Agent 5i ature Date (Revised 5/20/20�� Y� <br />