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- • PERMIT APPL{CATION • <br />BUILDING / MECHANICAL / PLUMBING ! SIGN / SPRINKLER / DEM�LITION <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 j www.everettwa.gov/permits <br />(Blue or Black Ink Only Piease) PROJECT SITE INfdRMATIQN <br />PROJECT SITE ADDRESS: �Z I��-v� �� PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �,»�� t„OIV�Qi TENANT NAME (if Commercial): <br />OWNER MAILING ADDRESS: s7aeer�I-'ZI �G�rK-�U�I �j1.P� <br />CI7Y ���i� STATE �/V� ZIP <br />PHONE: <br />ONTRACTOR NAME; <br />ONTRACTOR ADDRE <br />STREET ��' 4 `a� <br />� crrr CL11M1n�Y�l�s <br />CONTRACTOR PHONE: ��`?j �Gj� <br />CONTRACTOR LICENSE #(REQUIRED):,1+ Q�QN�rj� <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR <br />CONTACT NAME: <br />� � L�� <br />�OWNER EMAIL: {(Sj/ <br />and �i r Sd�s�l'I av�S <br />S7A7E <br />21P <br />CONTRACTOR EMAIL: j y�{d ,�, 'r 1� (Sy� Q, 1/�C,• <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED . . Cj'LI 6 <br />❑ OTHER (Please Specify) <br />CONTACT PMONE: � <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />isting Use of Building: Contract Price of W �$ q�4b �� <br />�posed Use of Building: Heat Source: G s ❑Electric Other <br />ilding Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />�e of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ClSign ❑Sprinkler ❑Demolition ❑Change of Use <br />;SCRIPTION OF WORK: �,� � ���,4 � �� VIGtP�' (J�l�` � C� �' Y'Q:1�1�� <br />� w�t �� �� <br />IASSOCIATED BUILDING PERMIT # (if aoolicablel: <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Fixtures tist of Fixiures Fi�ctures Lisi of F/xtures <br />Toilet Backflow Preventer (Inside Bldg) <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: f have revrewed this application and confrrm the informafion contained herein is true and correct. Work done pursuant fo this permit musi comply with <br />current federal, sfate, and local law. The granting of a permit only authorrzes app�oved work and no deviations therefrom. Devratrons must first be authorized in writing from the <br />Building Official be%re being authorrzed under any circumstance. I am the owner, or ! am authorized by the owner of fhis property to perform the work for which application is made, <br />and ! comply�vGiTf�e State Contractor� Law 98.27 RCW and 296.200A WAC. <br />Agent Signature <br />City of Everett Official Use Only <br />P I # <br />� � .._. <br />Date (Revised 9/23/2016) <br />