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� <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />TE ADDRESS: <br />L for new construction: Short PlaUsubdivisio <br />W N E R �/> yv� Y i� ��% j; i i`�- 7-�— <br />idress / � 7'D l C,zd�EC"�-- r..,i� 1::� <br />PPLICANT: _ Owner _ Owner's Agent _ Contractor <br />NTRACTOR � t;-L--t=— <br />B <br />BUILDING PERMIT APPLICATION <br />OPERTY TAX 4k <br />PERMIT # <br />No. (attach copy of long legal description) <br />Phone/E-mail <br />�City/State/Zip <br />Contractor�5 A9211Y _ T8f18f1t (must provide a letter of consent from lhe owner to do work in the space) <br />State Lic. # <br />Phone/Email <br />FOR PERMIT <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />City Bus. Lic. # <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric� Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family 7� Commercial <br />Type of project: New Addition Remodel � Repair T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� ��,� ��� �,� �`% �- � , '�-�1��� <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration �„Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />I Forced air svstems <br />� Water heater <br />Gas fireplace <br />j Gas range <br />Clothes dryer <br />•,c Range hood <br />�� � Exhaustfan <br />i Heat pump <br />; Unit heater <br />Boiler <br />; Refrigeration <br />; Woodstove <br />Ducting <br />� Other <br />I <br />PRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />! Toilet <br />9 ! Bathtub <br />�iie�� r <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner of this property to pertorm lhe work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />��Cr_�. �� �� /� � - /� <br />Owner/Authorized Agent Signature Date <br />(Revised 3/2013) <br />