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� � <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 />E ADDRESS: <br />for newconstruction: Short Plat/subdivision <br />'NER'C�•Ct�,�Ct•C� <br />ress �y��4�'� �,�, <br />�LICANT: _ Owner <br />NTRACTOR .(�\\ <br />ress 52.�.^► (��� <br />Owner's Agent J Contractor <br />PROPERTY TAX # <br />-. <br />Lot No._ <br />Phone/E-mail � <br />City/State/Zip <br />Contractor's Agent _ <br />1\C�49tate Lic. # 1`� <br />IT # <br />5 I? �, - O�-f� �-- <br />(attach copy of long legal description) <br />TBflBflt (must provide a letter of conseM from the owner to do work in the space) <br />�-� IPhone/Email <br />ACT FOR PERMIT <br />City Bus. Lic. # <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��+��.G�;` <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 />DESCRIPTION OF WORK (additional space provided on the backJ : <br />-�i�,��\y ���? �'.��`v.,�� q��\�\� �v �� 1` ' �1 N7���� <br />a 'V�- <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 ranqe <br />Ran e hood <br />Exhaust fan <br />Heat pum <br />Unit heater <br />Boiler <br />Refri eration <br />Woodstove <br />Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Urinal <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 comp <br />with whether specified her or noL 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 authorize by owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296.200A WAC. <br />� <br />.,i"� ,_� � � �/S <br />Own Authorized Agent Signature Date (Revised 9/2014) <br />