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PERMIT APPLICAi'10 <br />BUILDIN�MECHANICAL / PLUMBING / SIGN PRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-881 D � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMQTION <br />ZOJECT SiTE ADDRESS: ✓ PROPERTY TAX #: <br />%��/' ' lajru �-�= �-- <br />:GAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description} <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: <br />Proposed Use of Building: Heat Source: Gas <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units:_ <br />TypeofProject: ❑New �Addition f�Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler <br />DESCRIPTION OF WORK: 7 <br />.� <br />�� � <br />�j�i � /' 4��� ' Cti, <br />G%G�c�.�— �_ ; �� •' <br />���� i <br />ASSOCIATED BUILDING PERMIT # (if applicabie): <br />❑Electric ❑Other <br />❑Commerciai ❑industrial <br />❑Demolition ❑Change of Use <br />1���� <br />,,,; ..,. <br />p�LllM�1Al1G PERMIT APP�IC/4T'IORI <br />Type of Project: _New _Addn _Alteration _Repair <br />Fixfures List of Fixtures Fixfures List of Fixfures <br />Toilet Backflow Preventer (Insic <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />ShnwPr Floor Drain <br />Kitchen Sink & C <br />Dishwasher <br />Clothes Washer <br />Water Heater <br />Sink (Service/Ba <br />Roof Drains <br />Medical Gas <br />Ofher. <br />Other: <br />ACKNOWLEDGEMENT� 1 have reviewed this application and confinn fhe information contained herein is true and correct. Work done pursuant to this permii must comply with <br />currenf federal, sfaie, and local law. The granting of a perrnit only authorizes approved work and no deviations therefrom. Deviations must first 6e authonzed in wrifing from the <br />Building O�cial before being authorized under any �% umstance. 1 am tire owner, or I am authorized by fhe owner of this property to perform the work for which application is made, <br />and l mm�lv wiih the Sfate Coniractars Law 18.27�RCW and 296.200A WAC. <br />Owner/Aiitftorizetl�9gent signature <br />City of Evereft Official Use Only <br />cj�� / PERMIT #, I/ I I I`����� l�� <br />Y <br />Date (Revised 1 D/12/2015} <br />