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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: % / �,�� � PROPERTY TAX #i p�RIVI�T # <br />r � /( ! .� �i /� � /�'L/,����- I � . i � �� l � � - U( ; <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER % ,l.'J/yr� ;'f"�/.r'.t iC� � Phone/E-mail �-� ;i,`j — ''� 1 C� - � i � l,'�i <br />� ��%�' �� (./�/ ICity/State/Zip �� b �! L\ �� <br />e <br />ner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant (m�sc Provide a <br />ONTRACTOR �/�,i/���/' <br />BUSINES <br />BUILDING PERMIT APPLICATION <br />L&ILic.# <br />Phone/Email <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building G <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commerciai <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _ <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />�1 k��� <br />of consent from the owner to do work in the spaca) <br />COE Bus. Lic. # <br />HEAT SOURCE: <br />Other <br />ition Chan4e of Use <br />� � <br />� ' <�/�l�`� �22 �Z'/zl',�' ���' /`G�l� ��' - <br />f �- %�'��/,,��r �i'�-G'�� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION , <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />I Gas piping <br />I Water heater <br />� Gas fireplace <br />� Gas range <br />Clothes drver <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriaeration <br />Ducti <br />SPRINKLER / SUPPRESSION SYSTE <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />i Shower <br />i Kitchen sink & disposal <br />; Dishwasher <br />i Clothes washer <br />� Water heater <br />I Sink fservice/bar/moo/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <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 autf 'ae e wner of this p erty to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� <br />�--� �� �� <br />Owner/Authorized Agent Signature Date (Revised 6/2012) <br />