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• PERMIT APPLICATIO� <br />BUILDING / 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 />lue or Black Ink Only Please <br />PROJECT SITE ADDRESS: <br />PROJECT SITE INFORMATION <br />PROPERTY TAX #: <br />�LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) � <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 />o , <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures #�f Lisf of Fixtures # of List of Fi�rtures #°f List of Fixtures <br />Fi�ctures Fixtures Fiztures Fixtures <br />� A/C —Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bidg) <br />Forced Air Systems Unit Heater Bathtub Urinal <br />Gas Piping Boiler Lavatory (Wash Basin) Drinking Fountain <br />Water Heater Refrigeration Shower Floor Drain <br />Gas Fireplace Wood Stove Kitchen Sink & Disposal Grease Trap <br />Gas Range Ducting Dishwasher Roof Drains <br />Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br />Range Hood Water Heater Other: <br />Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and cor�ect. 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. Deviatrons must first be authorized in writing from the <br />Building Otficial before being authorized under any circumstance. 1 am the owner, or I am aufhorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />1� " j'� '(�, PE I�I 6 O� �� <br />� <br />Owner/Authorized Agent Signature Date (Revised 5/20/2016) �� <br />