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PERMIT APPLICATION <br />BUILDING�ECHANICAL / PLUMBING / SIGN / S INKLER / 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 />Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />'ROJECT SITE ADDRESS: �'j ( � � � �{7; '�; ��.� PROPERTI TAX #: _ 7 `� � � I i� �G� � <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />)WNER NAME: ��,,�)j,L ;� ;� j �; '�j^ �',j ��� � TENANT NAME (If Commerciai): ��C='��� �t i?G%s'j��,�'�j��� <br />ER MAILINGADDRESS: �� � j+�, � �"�' C: .�� !?.� r^; � ��)�"�C �i��_':��rs �;�'��c� 6���-s✓ � (;�.'�'1 /�_ <br />1 C��? <br />OWNERPHONE: (�i�C, <br />CONTRACTOR NAME: , <br />CONTRACTOR ADDRESS: <br />STREET `� � � j V � � <br />CITY .���'��.�6'�" <br />'-`��`'i')'1�� i�-', jc2 Y��Y_ <br />�. <br />� " �:7i, �^� fY) i:7 t 5- <br />STREEI' � � � ��� <br />OWNER EMAIL: %_ <br />�� <br />STATE ., . . . ZIP � '� �� <br />� <br />CITY �. STAiE f�,� ZIP �- C, �..J <br />CONTRACTOR PHONE: _ . '. , ,; . - ; � c ; CONTRACTOR EMAIL: '�' ,,_ -• ; " "; , _ . ; ; : , i ..,:r.%'. • <br />�� , <br />CONTRACTOR LICENSE #(REQUIRED): � L �7� _�j • � �,� �- CITY OF EVERETT BUSWESS LICENSE #(REQUIRED): ``� � ` ' '"`' <br />PRIMARY CONTACT: �rOWNER � CONTRACTOR � OTHER (Please Specify) �. � 5- <br />CONTACT NAME: CONTACT PHONE. � � � - ;: �� �— � � � � <br />����� C1, /� <br />i1::�: 'I �� .�� � �i/t� �/�,�i �s�, ✓ CONTACT EMAIL. IL:,2_ l. '� �(s� "`.i'� `L':�<`� f2��.�r' rt <br />BUILDING PERMIT APPLICATION <br />.� � <br />Existing Use of Building: ('.�:'. �`:�'� � � Contract Price of Work: $ / ��/ -ic?<= -- � <br />Proposed Use of Building: Heat Source: ❑ Gas �7 Electric 1 Other <br />Building Type: ❑ SFR-Detached ❑ SFR-Attached ❑ Duplex �I Muiti-Family�# of Units: ❑ Commercial 7 Industrial <br />Type of Project: 7 New '7 Addition � Remodel f_�_Repair ❑ T.I. ❑ Sign ❑ Sprinkler ❑ Demolition ❑ Change of Use <br />DESCRIPTION OF WORK: T <br />f'1 <br />!G C ' r �i� �-� � <br />IASSOCtATED BUILDING PERMIT # (if aa�licable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of list of Fi�rtures # of List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bidg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor 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.� ! have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to thls permit must comply wdh <br />current federal, state, and local law. The granting of a permd only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of thrs property to pertorm the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296200A WqC. <br />City of Everett O�cial Use Only <br />PERMIT # <br />� � (�� 7 � ��� �, <br />(Revised 5/20/20f6) � <br />� <br />