|
�� �
<br />I�►' � -
<br />�
<br />PERMIT APPLICATIO �
<br />BUILDING i IIIECHANICAL / PLUMBING / SIGN`fi-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 AD SS .� `, F ` . A`� `.` !_ PROPERTY TAX #: � . � � �_; _ - , . .
<br />� ( , , � o`,�_ �I( i
<br />LEGAL for new construction: Short PlaUsubdivision '� Lot No. (attach copy of long legal description)
<br />CONTACT INFORMATION
<br />OWNER NAME: ` ;s � �,,; � 4 ��,d' � �� �,, t ;"�, r � �'i't �, �� TENANT NAME (If Commercial) ,�i� .L-', ; l� i' �� �� � ; �+ I �� �� � , ;_ �
<br />OWNER MAILING ADDRESS: srReeT �� �I � (' r � � (: (.; ( �� � . l: ., :
<br />crrv 1..: �. � � � `f �. l � srnre �, � �-\ zia � ( �� _�) C ' �
<br />OWNERPHONE: �Z-��; '�i`'7�>"i'';C,���-d OWNEREMAIL: 1'�!j,��\
<br />CONTRACTOR NAME, �• � ,_= � � 1 �l�_�� `; �� � � '� f' `_�� ! i �- � P. v v<<
<br />CONTRACTOR ADDRESS: srReer -�' ;� � ` � �,� (. � �� t t I� '1 ;� �;��: � � � � �;�
<br />, � / � - ,;- .�
<br />CITY � . � p � � STATE �J�'�� �-� ZIP ��, � � � �
<br />CONTRACTOR PHONE: ->' (_ �;� -� � �. ; ' �� ;� CONTRACTOR EMAIL:
<br />CONTRACTOR LICENSE #(REQUIRED): i� 1'`�_ I I�-� ������ �! �1 I��.y � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED) i�� �; ', '�! ;'� j
<br />PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify)
<br />CONTACT NAME: CONTACT PHONE: � � a • � =� ;_ ��i �Ji,-' ,} .�
<br />�`� � � !�,'��� �!% �°v�ti� Ci �� �C' ��� CONTACT EMAIL: h V . �. _ 1r .'�E�t Y��( �'- -, (
<br />BUILDING PERMIT APPLICATION
<br />Existing Use of Building: ;`� � f�-�� �� Contract Price of Work: $ i=-? 1��' �'�
<br />Proposed Use of Building: �1 � t"f.'. � t Heat Source: ❑Gas ❑Electric ❑Other
<br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Muiti-Family-# of Units: �Commercial ❑Industrial
<br />Type of Pro'ect: ❑New ❑Addition ❑Remodel ❑Repair QT.I. ❑Sign �Sprinkler ❑Demolition ❑Chan e of Use
<br />DESCRIPTION OF WORK: � -
<br />,
<br />. i ��li_,�.�. tYv'���F�vY.; . ���� _ ��dc(�� i'ti�l i o�' L';_, �,��ir�, v����t 'v� ;v� i.�.._i t-� `�-
<br />� �,��: <�. 'v��; - �;� li-� �v,, . 'f�� rv�c ;�t, l_.,���. �-���;__c'_1. . ; y=' < <•�1i l: , , �•. � c�_. ��, l� �i�� _.
<br />, 1 �i..-
<br />�',C,�� , _.i��-�v��'�� ��. � �
<br />ASSOCIATED BUILDING PERMIT # (if applicable):
<br />PLUMBING PERMIT APPLICATION
<br />Type of Project: _New _Addn _Alteration _Repair
<br /># of List of Fixtures # of ��st of Fixtures
<br />Fi�ures 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 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 (rom 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 periorm the work for which application is made,
<br />and 1 comply with the State Contracfors Law 18.27 RCW and 296.200A WAC.
<br />�I �•; t. City of Everett O(ficial Use Only
<br />� �, , � I "�L�' � P MIT # „�,�
<br />� �,' � �; C � _���� �_ t -r �t.;�',��I�,����,�1,+-�� , � �� �''_����i�-��`� � '� "l,'"
<br />Owner/Authorized Agent Signature �� Date � (Revised 10/12/2015)
<br />
|