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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM
<br />ITE ADDRESS: -. PROPERTY TAX # RMI #
<br />J�. I 2_ IZ �: r_�C lA, � 03 cXJ c�
<br />for new construction: Short Plat/subdivision
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<br />ACTOR Sct+-�.-�., c,-� ti��,n Lc4
<br />T BUSINESS NAIVIE
<br />_Lot No. (attach copy of long legal description)
<br />Phone/E-mail ( 20 � ) Gn 5 - �
<br />City/State/Zip i.�(; � �d :� J� `'l �/I a 2.
<br />L& I Lic. # 5�-ne�c � c��a�,,,, ,:�
<br />Phone/Email
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<br />E-mail J L�� 1 ,7,7�: ,
<br />2;�� ��� -
<br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � 3 S��J "'
<br />Existing Use of Building �s,�; C.l� v� ii u�( —�J r+ L[i;� � HEAT SOURCE:
<br />Proposed Use of Buiiding i7cs _���-��� �� �- �-L�v� C4 � Gas_ Electric Other_
<br />Building type: D� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial ��h � 4�� 'N'�' ��` �' � 5 ��
<br />� :.o �, ; � ry � ,v ., 11
<br />Type of project: _ New _ Addition _ Remodel _ Repair � T.I. _ Sign _Sprinkler _Demolition_C�nge of Use
<br />DesCfiptiofl Of WOfk (additional space provided on the back) : Q y„ y� r �-� � u+� 4� U„„� ,N•� , � S: � �<.,y ri S,, n�:,, �,�O.n
<br />u�-i� �Icin��,dN��,�"� ` 1„y��61 wt�.�..� Z..lc�-1(�,1 v��.�;-, 4:.,,\�, w�A V �l'
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<br />Have you started working without a permit? _YES � ' NO �(� 6 q (.e_- f an�1�w•�.G ' ¢�� �{ �j�#,� �Z� � � /� ,-� ,
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<br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br />of Project: �New _Addn �Iteration D�Repair
<br />Show Number (#) of fixfuies
<br />� A/C - air handling units
<br />� � Forced air systems
<br />� Gas piping
<br />vvater neater
<br />Gas fireplace
<br />Gas ranqe
<br />Uiotnes arye
<br />Range hood
<br />Exhaustfan
<br />Heat pump
<br />Unit heater
<br />Boiler
<br />Woodstove
<br />SPRINKLER / SUPPRESSION SYSTEM
<br />Number of Heads
<br />Type of Project: _New _Addn _Alteration �Repair
<br />Show Number (#) of fixtuies
<br />� i Toilet
<br />� Bathtub
<br />Lavatory (wash basin)
<br />I � Shower
<br />� ! Kitchen sink & disposal
<br />� i Dishwasher
<br />� � Clothes washer
<br />� � Water heater
<br />� � Sink (service/bar/mop/etc.)
<br />! Backflow preventer
<br />Urinal
<br />( Drinkinq Fountain
<br />�rease 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 pertormance of construction. That I am authorized by the owner of this property
<br />to perform the wo for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC
<br />1 � �2— 1,
<br />O ner/Aut n gent Signatu e Date (Revised 2/2011)
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