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• PERMIT APPLICATIO� <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />320Q CEDAR STREET, �VERETT, 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 />PROJECT SITE ADDRESS: ,� I` �L C 1`�� j'� :� �, �. PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />NAME: <br />MAILING <br />WNER PHONE: �-J ; <br />ONTRACTOR NAME; � <br />ONTRACTOR ADDRE�S: <br />STREET �v � <br />cirv � (,� �= � � <br />`�- >"��.;'- % �'�' <br />�� �' � c�.� � <br />� � <br />STREET �- �� �� <br />CONTACT INFORMATION <br />/ i <br />< �4J � TENANT NAME (If Commercial): q'� � �JL( r ( �i � �,('� � ,�ij <br />c%i �`lr%� <br />` � / <br />� STATE �' ,,�� ZIP ��'(�J <br />OWNER EMAIL: I C�I �'� � � i`� L� di ��-� . LC �1 <br />�D,n � i <br />�': X � `l �%� <br />CITY �--� '�� ('E' �� STATE I��l, �.� ZIP C� Y s`li1 C�� <br />ONTRACTOR PHONE: �i `�� �� ��`>CJ �� � � �, CONTRACTOR EMAIL: � � C � � � � r'\ � 1 ' �i G�� � �� , C �>- `' <br />ONTRACTCI2 LICEN�S€ #(R[QUIREQ): CITY O� €V�R@TT BUSINES� LiCENSE #(R@QUIR D): <br />RIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR � OTHER (Please Specify) t=' a c �-t <br />�-, - <br />ONTACT NAME: CONTACT PHONE: y � � - � � �� - �- f j ' , <br />�— 1 6 i�=� l.__ G;. '�'�• 'r� j,�'i �'� �O��TACT ENiF,IL-c l�l� �� � ,-�' � <br />� -.<-; � Gt- -I G(l(`�C IS�,Ir:t <br />BUILDING PERMIT APPLICATION -�--�-� `? <br />Kisting Use of Building: f� �� �%� �, Contract Price of W :$ <br />roposed Use of Buildin : C�� ��_ �, � � Heat Source: �1Gas '-`�t���iti� ���lOther <br />uilding Type: ❑SFR-Detached ❑SFR-Atta hed ❑Duplex ❑Multi-Family-# of Units: �(Commercial ❑Industrial <br />ype of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition �Change of Use <br />ESCRIPTION OF WORK: <br />� � . �-. '�,,_ � - -, <br />, <br />��C� � n`l C �v� G.,� L� � L�,� � -�� �� c-�� � � ��� �.�r`�1 <br />k�� ��� �1��-,��' 1^--� v <br />�:�C� � �� 1 �� � � h ����� � � �l Ci� w �� � <br />SSOCIATED BUILDING PERMIT # if applicable : L��� 1`� ��,^C�� '^ �'� � �� G 1 � l,� i�-1 7 l'1'�'` S <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Fi tures List of Fixtures Fbrtu es L/st of Fixtures <br />Dishwasher <br />Clothes Washer <br />Water Heater <br />Sink (Service/B� <br />Other: <br />Other: <br />n <br />ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit musf 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 from the <br />Building 4fficial before befng authorjZed under any cirrumstance. I am tire nWner, or I am authorized by the owner of this property to pertnrm the ivnrk f�r whrrh appticatrnn is made, <br />and ! comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Oflicial Use Only <br />i � � °9� <br />P 11� <br />� ��� � <br />(Revised 5/20/2016) <br />\ V <br />