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PERMIT APPLICATI� <br />BUILDI�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 />I BUILDING PERMIT APPLICATION � <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached <br />Type of Project: ❑New ❑Additio <br />DESCRIPTION OF WORK: <br />Contract Price of Work: $ <br />Heat Source: ❑Gas ❑Electric ❑Other <br />❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units <br />n ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprink <br />���/tir� �����.��.���' <br />ILDING PERMIT # if a licable : <br />TED BU ( pp ) <br />❑Commercial ❑Industrial <br />❑Demolition ❑Chanqe of Use <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />��f List of Fixtures # of List of Fixtures #�f List of Fixfures #°f List of Fixfures <br />Fixtures Fixtures Fixtures Fiztures <br />A/C — Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) <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 />Nurnber of Heads <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to ihis permit must comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Bui/ding Official befo�e being authorized under any circumstance. I am the owner, or I am authorized by the owner of ihis property to perform the work for which application is made, <br />and I complv wiih the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� - `� �--r�-/� <br />Owner/Authorized Agent Signature Date <br />City of Everett O�cial Use Only <br />PERMIT # <br />�� UG���V� <br />(Revised 90/12/2015) <br />