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PERNIIT APPLICATION <br />BUILDIM�ECHAiVICAL / PLUMBIIVG / SIGN �RIfVKLER / DEIVIOLITION <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 />" PRO.JECT SITE 1NFORMATION <br />_ __ __ . <br />KVJCI. I ai � C t+uvrc�o3:/I �// �� /% iti �,J� PROPERTY TAX #: <br />/ l T�c_�/ U <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />"' BUILDING' PERMIT APPLICATION ' ' '` I <br />Existing Use of Building: �/L /L Contract Price of Work: $ �� �� <br />Proposed Use of Building: ��2 Heat Source: ❑Gas �Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached C1Duplex ❑Multi-Family-# of Units: �Commercial ❑Industrial <br />Type of Project: ❑New �Addition �emodel C7Repair ❑T.I. ❑Sign �Sprinkler ClDemolition ❑Change of Use <br />DESCRIPTfON OF WORK: 7 ��J �n��7-��v�a-L %�v�TL7��'� � <br />%` �`''Z fLC0,0/zC... O�' %��%l `i ���G� / <br />f-'{�,l ►� W,�slf �z�Z ,D/zYJ�� Ff A��4-- � <br />�ASSOCIATED BUILDING PERMIT # (if applicable): <br />_7 <br />PLUMBING PERMIT'� <br />Type of Project: _New Addn <br /># of List of Fixtures # of <br />Fixtures Fixtures <br />� y Toilet <br />Bathtub <br />� v Lavatory (Wash <br />� Shower <br />Kitchen Sink & C <br />Dishwasher <br />Clothes Washer <br />Water Heater <br />PPLICATION <br />_Alteration _Repair <br />List of Fixtures <br />Backflow Preventer (Inside B <br />_ Urinal <br />Drinking Fountain <br />Floor Drain <br />Grease Trap <br />Roof Drains <br />Medical Gas <br />Other: � <br />Other. lGK wtY-# r� r�2 <br />ACKNOWLEDGEMENT.� 1 have reviewed this application and confirm the information contained herein is frue and correct. Work done pursuanf to this permit must comply w�tn <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviafions therefrom. Devrafions must first be authorized in writing from the <br />Building O(ficial before being authorized under any crrcumstance. I t�m the owner, or I am authorized by t/te owner of this properry to perform the work (o� which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.2u0A WAC. <br />orized Agent Signature <br />City of Everett Off�aal Use On/y <br />PERMIT # � <br />� `z �' / � lJ� 1.� � 1 � <br />Date (Revised 10/12/2015J ` / <br />�Z <br />