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. � • • <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVECES <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 # PE MIT #� <br />S 1��� /�/�iZ�3L.=c1C ,�% i.u�= ;'�� � �'b � �- � <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />�� <br />� <br />NTRACTOR L,��a1:f7�7� 3 <br />ress 2-1 Z� yl�C� i-c C. <br />Phone/E-mail � "'ZS � <br />� � �.,. CitylState/Zip �;�/r�,.y�� A �.,�i..�v� <br />�r a <br />�Z %f�-�4T �i �t �. L& I Lic. # i:UI��.G: 5 SCr"ZZC'T <br />Phone/Em <br />� <br />�-1� <�:•E c..� <br />Phone/E-mail — � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric� Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />c <br />Descriptlon of Wofk (additiona! space provided on the back) :'� z��S f� -t ' I,�5�� � i cl � � <br />�.�5-r�. .t � � [.��s �-lc�t � � -:.`�.�� <br />Have you started working without a permit? YES �NO <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air svstems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes drver <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />Shower <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Water heater <br />Exhaust fan Sink service/bar/mo /etc. <br />Heat pump Backflow prev�nter <br />Unit heater Urinal <br />Boiler Drinkin Fountain <br />Refri eratiori Fioor drain <br />Woodstove Grease trap <br />Ductin Roof drains <br />Other Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads 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 <br />this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the provision of any other state o[ local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform he ork for which�pplication is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />�,Z�_�� <br />OwnerlAuthorized Agen ure Date (Revised 2/2011) <br />