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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 # pERMIT # <br />�z� L 12c�c.tc.� L !,�Jti-3�a--���o�a ZC�o� }� ;�C:�'-� _ C1? I <br />eo � <br />LEGAL for new construction: Short Plat/subdivision� ��� Lot No.� (attach copy of long legal description) <br />OWNER ty �'r' .ti ( �f J , �' � � l�C. L. Phone/E-maii 2lJC� ��S - `�r7 `j 2- � L.ci � �'� � u C•'{o✓ � <br />Address �� �x �� 2�L City/State/Zip Wr/�,E;w� � ilo._, y �o �� �� c� �' � � . � ^ <br />ONTRACTOR <br />>INESS NAM <br />�p <br />v/ ,7 �d._�L L& I Lic. # 5 �- i7 C� C L i <br />BUILDING PERMIT APPLICATION <br />Email <br />CONTACT FOR PERMIT <br />� r ) <br />Phone/E-mail 1 �'- � �n� �- l ��`/ � ��^ ' �n �� L <br />CONTRACT PRICE OF WORK Zi 7'%I O.� <br />Existing Use of Building � ��-✓� � 2 HEAT SOURCE: <br />Proposed Use of Building /`�- -[ I� s/° %L 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 back) : i y'� <br />, -� ;� ,�_-����;��� �,� -��-���i��+� ;r;� �r . �����,. ,,�� i ��>�- �_ l. <br />Have you started working without a permit? _YES �NO <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fiatuies <br />� A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />i Water heater <br />! Gas fireplace <br />Gas range <br />Clothes dryer <br />j Range hood <br />Exhaust fan <br />Unit heater <br />Boiler <br />Woodstove <br />Ductina <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteretion _Repair <br />Show Number (#J of fixtures <br />i Toilet <br />Lavatory (wash <br />Shower <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Water heater <br />Backflow pre <br />Urinal <br />Drinking Fou <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 <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 or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform the o for which appl'cation is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />� �l /� V <br />O ner/A h ri d ent gnature Date (Revised 2/2011) <br />�� <br />