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PERMIT APPLICATIO <br />BUILDIN�VIECHANIGAL / PLUMBING / SIG PFtINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVIC S <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 />PROJEGT SITE INFORMATION <br />PROJECT SITE ADDRESS jG" jc ���� /f �� SC PROPERTY TAX #: <br />7 <br />LEGAL for new construction: Short Plabsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: /l/�i.G�%if��= �, �`j(r�/f/7/�/�/�/ TENANT NAME (If Commercial): <br />/< << `,� c,, i� � <br />OWNER MAILING ADDRESS: sTReer � (� / �/Z :��, <br />cirr �IIC- /ZL / � srnTE �iCi .7g ziP <br />OWNER PHONE: �%,� :j S�� "- 3L[i �� OWNER EMAIL: <br />_. _ ... <br />CONTRACTORNAME��/t/j=/Z� �C`�„LC�= �C.�(Zl/�C�= S C�LC <br />CONTRACTOR ADDRESS: sTREEr � 3,� 3 CJ s j �%V L ��� � _ <br />CITY �� �" 1 / lZ� STATE �.� ' ZIP � <br />CONTRACTOR PHONE: ��� �S -� ��j ��;3�� CONTRACTOR EMAIL: ��/2-C= , �-/C��'��I/�! %J� C�' <br />CONTRACTOR LICENSE #(REQUIRED):.��/`lZ,� S t, �'' � 1C_-�— CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �`) <br />PRIMARY CONTACT: ❑ OWNER �CONTRAC <br />TOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: G�� �=�-�� -- 3��' <br />`-� /Z(_;" � � iC%'�i�(�J (Z CONTACT EMAIL �;%Z-L ,, /�L:" �l'.'g-hI,(�L ��S' <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ ��J�� ��%�.i <br />Proposed Use of Building: Heat Source: as ❑Electric ❑Other <br />Building Type: ❑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 />� �. C�� C_f� ( .L v/�.� �j (— I �� L- (�[ >'� _ S /�'L�� L (�— <br />�ASSOCIATED BUILDING PERMIT # (if applicable): <br />� <br />" , ��!` <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />#°f Lisf of Fixfures #°f Lisf of Fixtures <br />Fixtures Fixfures <br />Toilet Backflow Prevenfer (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 rs true and correct. Work done pursuant to this perm�t must comp�y wirn <br />current federal, siate, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations musf first be aufhonzed in writing from the <br />Building Otficial before being authorized under any circumstance. 1 am the owner, or I am authorized by the owner of this properfy to perform the work for which applicafion is made, <br />and l comply with fhe State Confractors Law 98.27 RCW and 296200A WAC. <br />/ � Cify of Everett Offrcial Use Only <br />� � PERM T # <br />i�,- �- .--�1 � / �� � � � � � <br />er/A � orized A t Signature Date (Revrsed 10/92/2015) <br />