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� PERMIT APPLICATION � <br />. .. ` V �/�j -_ <br />' � �.� <br />� <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER��� MOLITION <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 />ROJECT SITE ADDRESS: t r PROPERTY TAX #: � <br />�: � � I �-�� �^ � VG �L �- � �`� ��-� J"� �O <br />for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �� ��!'� ^�j �/ TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREeT t� -� <br />CI7Y �V�Y(J� STATE ZIP � � <br />OWNER PHONE: L� 2 � Zj� — U Jo OWNER EMAIL: <br />CONTRACTOR NAME: U�J �-{ . – :J J `=�'�� – �� �/� � ( �; � <br />CONTRACTOR ADDRESS: srReer � �:1� � � � � S � SV�/ <br />CITV STATE ZIP ��� '� � <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: �1 ��0�, �t� � /) � � � nn <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENS #(REQUIRE ): <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ��, 7� ;_ C Z <br />� (i �/rl��/� L%%`'✓ 1 � CONTACTEMAIL: „. _t, ,,,' ,,,'ii.. c n. �'�;^, <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ <br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />Building T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�Q1J:�� � Wl vY <br />C <br />ASSOCIATED BUILDING PERMIT # if applicable : <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New Addn Alteration Repair <br /># of List of Fixtures # of List of Fixtures <br />Fixtures Fixtures <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: 1 have reviewed this application and confirm the information contained herein is true and conect. Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granfing of a permit only authorires approved work and no deviations the�efrom. Deviations must first be authorized in writing from the <br />Building Official 6efore being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />r <br />Agent Signature <br />City of Everett Official Use Only <br />PERMIT # <br />� `l.�V � <br />(Revised 10/12/2015) <br />��,'.1 Ja�% <br />