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PERMIT APPLICATION <br />BUILDINC�IECHANICAL / P'LUMBING / SIGN �RINKLER / DEMOLITION <br />CITY OF E\/ERETT PERMIT SERVICE <br />3200 CEDAR 3TREET, EVERETT, WA 98201 <br />(P) 425-257-$810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITEE INFORMATION <br />OJECT SITE ADDRESS: 4� � Z 5e�w►�.sfi. �✓� PROPEI2TY TAX #: vv S � S% f�OOO I O O ( <br />GAL for new construction: Short PlaUsubdivision _Lot No. (attach copy of long legal description) <br />CONTACT IINFORMATION <br />OWNER NAME: �Uy�,�c.C.c� WLG�-v� � c�- Cr�-+i'"%�2 t�' TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srneer 470 � S 2C.e.LIC�,�''S-�" /�V � <br />CITY �VQjt/'��'� STATE W f�C ZIP �✓ 4�O � <br />OWNER PHONE: 4 Z5 • 2.52. •�O (�,'-% OWNE:R EMAIL: YVtu-V'iG�. �a �a-r'Y�v�� ��vp .�o-�-a1 <br />CONTRACTOR NAME: �j S 1NGwl S rh`L- �j'u�Cx-visv'Y�. N�. Q G,l��u�vi � c�.G <br />CONTRACTOR ADDRESS: srReer I(o$ ?j f �/1/j L�iGi�_ � c7 u-eA� <br />cirv I��.r l i n -�yn 1�1.1,�c srwrE ziP G% �a � <br />CONTRACTOR PHONE: 4ZGj� �j �jGI -� vI `( CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): S W A T�yM 1. ��( L�j CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �'� <br />PRIMARY CONTACT: OWNER CONTRACTOR ❑ OTHER (Please Specify} <br />CONTACT NAME: CONTACT PNONE: <br />VY�GLY' I A- C�W'%d✓' b� K Q I H� J N%� �1.. CONTACT EMAIL: <br />BUILDING PERINtT APPLICATION <br />Existing Use of Buildin : sl� yeS,�.�!l,t,t.e..¢,� Contract Price of Work: � <br />Pro osed Use of Building: " '� �� Heat Source: ❑Gas fH'�ectric ❑Other <br />Building Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑PAulti-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition L�Remodel Li�tepair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: ��� ����J �_ ���V��� a J„ ..��� J <br />- v.u.�, <br />ASSbCIATED BUILDING PERMIT #(if a plicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration ✓Repair <br /># 01` List of Fixtures # of List of Fixtures <br />Fixtures Fixtures <br />Z Toilet Backflow Preventer (Inside Bid ) <br />I Bathtub Urinal <br />2 Lavatory (Wash Basin) Drinking Fountain <br />Shower Fioor Drain <br />1 Kitchen Sink & Disposal Grease Trap <br />� Dishwasher Roof Drains <br />1 Ciothes Washer Medical Gas <br />J Water Heater Other: <br />Sink Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: I have revrewed 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 NroHc and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building O�cial before being authorized under any circumstance. 1 am the owner, or 1 arn authorized by the owner of this property to perform the work for which appiication Is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�'%w,,�,w ���th- `� � !� • /�� <br />Owner/Authorized Agent Signature Date <br />City of Everett O�cial Use On/y <br />PERMIT# �r���I�� <br />(Revised �0/12/2015J <br />