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PERMIT APPLICATION <br />BUILDING 1 MECHANICAL / 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 />DJECT SITE ADDRESS: PROPERTY TAX #: <br />a. 11ft� L�'.�iv14�'1 �i.`C� �d S��%tiC:t� d�� ��' <br />3AL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: � �C��% rG ' d-•��� 'L'S � L. � TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReeT � �~ (� Iv � <br />CITY ��` SC� 1 l� STATE �J �"-1 . ZIP �j � / V <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: 0.0 �^ 1.�'V�'+�E'� ��M� S <br />CONTRACTOR ADDRESS: srReeT q ZZ �-I'+`� A-Li N� <br />CITY �y SV l��� STATE �j✓� ZIP �� Z v <br />CONTRACTOR PHONE: �Z�—Z� C,'—Z� Z�T CONTRACTOR EMAIL: �C�-' l �C��CIr�V�v C'•�-yl��r$�c C����Vj <br />CONTRACTOR LICENSE #(REQUIRED): CS�,IJ� � Z� j� D z CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): OS � CI �J / <br />PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �ZS= ZQL --Z� ZI <br />��� �T �l� CONTACT EMAIL: `�;e l I�ciuci,c b� kl�ev-S <<<%�� <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 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 />1Je� 5��' �-';+t� a+�a���e� ���-�cYe <br />z� -� 3 �+ <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: � C�New Addn Aiteration _Repair <br />Fixtures List of Fixtures Fixtures List of Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />3 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: I have reviewed this application and confirm the information contained herein is true and correct Work done pursuant to this permit must comply with <br />current federal, state, and local law. The grantrng of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in wnting from the <br />Building Officia! 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 application is made, <br />and 1 comply wrth the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent <br />�-2d--16 <br />Date <br />City of Everett Official Use Only <br />PERMIT <br />���C i-�� <br />(Revised 10/12/2015) 1 /� <br />I <br />