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- � <br />' <br />• <br />• <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 />P�DRESS: n ,.,� PROPERTYTAX# ,P6{tMIT# <br />/ ��� �u _•lrz�' ��✓'P Y Z� D/` �'t �c: +- - �; c: �; <br />►L for new construction: ShoR Plat/subdivision Lot No. (attach copy of long legal description) <br />ER si�{-� yrA�/ Phone/E-mai�y�� G(Q�—' O�d� <br />ress <br />ress a �/ W <br />Owner _ Owner's Agent � Contractor <br />/ � � /� N � . <br />�<, �� ��f�y <br />BU/LD/NG PE M/T APPL/CAT/ON <br />�City/State/Zip <br />Contractor's Agent _ <br />L & I Lic. <br />m�� <br />T2f18f1t (must provide a letter of consent from tl�e owner to do work in the space) <br />�i CCD�DC COE Bus. Lic. #O�-� � <br />/� � <br />Phone/E i � � 3 �O O/�� �O� <br />' iG0/, /1i�lw,nC�y"Gy ' �T��YC. fC/'� <br />� <br />CONTRACT PRICE OF WORK � Y�Q� -� <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family �Commercial <br />Type of project: New Addition Remodel Repair � T.I. _ Sign _Sprinkle <br />DESCRIPTION OF WORK (additional space provided on the back): � <br />.�n 3T�ll ,%C� Confi�f7�.Pi� /'adr2 � <br />MECHANICAL PERM/T APPL/CAT/ON <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of Fxtures <br />A/C – air handling units <br />Forced air svstems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />ISUPPRESS <br />Number of Heads <br />HEAT SOURCE: <br />Electric Other <br />Demolition Change of Use <br />'Pi�/S�� �"`^/1�`L�cG1ir. <br />c <br />PLUMB/NG PERM/T APPLICAT/ON <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of flxtures <br />I Toilet <br />Lavatory (wash basin <br />Shower <br />Kitchen sink 8 dispos <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/barlmoF <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 hue and correct. AII provisions of laws and ordinances goveming this type of work will be complied <br />with whether specified herein or not. The grantlng of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating constructlon <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />- - ��� ����� <br />Owner/Authorized Agent Signature Date (Revised 6/2012) <br />/� <br />