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PERMIT APPLICATION <br />BUILDING�ECHANICAL / PLUMBING / SIGN �F2INKLER / 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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �! ,�j� � � JPrio �� (,�,�',� `/ PROPERTY TAX #: _ <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />ER NAME: L. <br />vr <br />MAILING ADDRESS: srReeT <br />PHONE: <br />ONTRACTOR NAME: <br />ONTRACTOR ADDRESS: <br />ONTRACTOR PHONE: <br />ONTRACTOR LICENSE <br />CITY <br />CONTACT INFORMATION <br />TENANT NAME (If Commercial): <br />OWNER EMAIL: <br />� {�1 �' L <br />_� <br />STREET �� f 3�. �� I%f I/ j y y �-��" �/l�V� / v <br />STATE <br />ZIP <br />CITY I , STATE t./�/(�-�- ZIP � V / Sc � <br />��j / 'Z� CONTRACTOR EMAIL: Ck��,j �... �.. k� ��� /� - �C � <br />ED): �' ��/V"C �t� U(n� I3�� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):���J(� i <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR <br />CONTACT NAME: <br />,I Gl <br />OTHER (Please Specify) c. <br />CONTACT PHONE: i <br />CONTACT EMAIL: ��� �,P �.,� <br />BUILDING PERMIT APPLICATION <br />. � <br />Existing Use of Building: Contract Price of rk: $` ` � <br />Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br />Building Type ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ommercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />T�PI'�co d-� ��t- �}P� fi+.cc� `-�`'��5 � �l - ���t iy�s. .� ��5��,����tw ���� �J-�rik� ��a l�J. �Pw C������ <br />�r�� � � �1p5 � 1;�1�.� �� X�r�s, j��� ��er ��� � �. ��� �is�,es, '�.��, �e '�12 c�cc:eb► b�e , <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERI?AIT APPLICATION <br />Type of Project: _New _P,ddn _Alteration _Repair <br /># of List of Fixtures �� �f 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: I have reviewed this application and confirm the information contained herein fs true and correct. work done pursuant ro m�s permit must comp�y w�tn <br />current federal, state, and /ocal law. The granting of a permit on/y authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorize under any circumstance. I am the owne� or 1 am authonzed by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contrac rs Law 18.27 RCW and 296.200A WAC. <br />Signature <br />City of Everett Officia/ Use On/y <br />PERMIT # <br />� �C <br />�C����C��a� <br />(Revised 5/20/2016) t <br />2 <br />