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PERMIT APPLICATION• <br />BUILDING�ECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <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 />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: /� i a n �� ���,/, /' <br />"/�' l v � �Yid <br />LEGAL for new construction: Short PlaUsubdivision <br />No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />ER NAME: L � 0 � ��l �-��V�,� ���,� �� �- TENANT NAME (If Commercialj: <br />ER MAILING ADDRESS: sTReeT �,1 1„0� �fL . J�', S'� D <br />CITY � ���� STATE �� ZIP � <br />ER PHONE: �,��I.�J � J`� "1 ''� ��� OWNER EMAIL: 1 1 ��Vl ��I�1 i I l I�1j% .��l <br />NAME: � Iri:tiV (� � <br />ADDRESS: srReer <br />CITY LjV <br />:ONTRACTOR PHONE: �ZS� �J%>`J <br />:ONTRACTOR LICENSE #(RE(1UIRED): �L <br />'RIMARY CONTACT: ❑ OWNER ON <br />:ONTACT NAMEs� ` � � (��A n I �.� <br />i-�Y�',c�l� � �v� 1�� � r,��, <br />�-i Vl�� 1 � C: . <br />�X ��� <br />�� V � V� STATE (J J�'-T ZIP C�����"� <br />��ZS CONTRACTOR EMAIL: i �' .�'�, (/) �C�'V D1�OiJ�j, CJ��`lN� <br />��� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />TRACTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: �l� 1-f- —�'J"��;�" <br />CONTACT EMAIL: � ��,�'�/l � � ��`�,) � �I� f� , (v��/1� <br />Existin Use of Buildin : <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached ❑SFR-Attache <br />Type of Project: ❑New ❑Addition ❑Remodel <br />DESCRIPTION OF WORK: <br />�-� V � � �� ��� � fi. <br />l <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />BUILDING PERMIT APPLICATION <br />Contract Price of Work: <br />Heat Source: ❑Gas <br />d ❑Duplex ❑Multi-Family-# of Units: <br />❑Reaair ❑T.I. ❑Sian ❑Sprinkler <br />YJ� <br />2�1,���. vD <br />❑Electric ❑Other <br />❑Commercial <br />❑Demolition ❑Chan< <br />❑Industrial <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn Alteration Repair <br /># of List of Fixtures #�f List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavato (Wash Basin) Drinkin Fountain <br />Shower Floor Drain <br />Kitchen Sink & Dis osal Grease Tra <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/BarlMop/etc.) Other: <br />ACKNOWLEDGEMENT: I have reviewed this applrcation and confrm the informatron 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 work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which appircation is made, <br />and ! comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent <br />Cdy of Everetf O�cial Use Only <br />PERMIT # � � � � � � � � � <br />� "3- � �-r' <br />Date (Revised 10/12/2015) 1 I <br />. � <br />