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� <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 />ADDRESS: � �- ,� PROPERTY TAX # RMIT # <br />5�� �rr:,� l�. �f�.?��?� � t i `�.�� -uz` <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER �/�Y�/%�U1 (�1,1.iI�tIW Phone/E-mail {!rL� "l��`� "� I�Y�',-� ��itnr�u � <br />�' �`( ���: <br />NT: �Owner _ Owner's Agent _ Contractor _ Contractor�S A90flf _ T0f18f1t (must provide a letter of consent from the owner to do work in the space) <br />L & I Lic. # <br />Phone/Email <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building /1 �1"-+e. <br />Proposed Use of Building Ga <br />Building type: Single Family Duplex Townhouse Multi-Family Commercial <br />COE Bus. Lic. # <br />HEAT SOURCE: <br />Other <br />Type of project: New � Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCI�IPTION OF WO K(addi ional space provided n the back) : � ` <br />� � J ��` )� ,^ <br />�,�;j�i���{• � �'�.j,rV G'�G"u�� , �''��„i'�.�1 i��� ��.r� �, (Jr`•V'��'�� C'1����� <br />� ' �" 1 <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fiactures <br />� A/C — air handling units <br />! Forced air systems <br />a Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />i Clothes drver <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Other <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />I Bathtub <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Sink (ser <br />Backflow <br />�rease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined thfs application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or noS,The grenting of a permd does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />i <br />That I am authorized by the ownei� of�this pr erty to rtorm the work for which application is made and I comply wdh the State Contractors law 18.27 RCW and 296.200A WAC. <br />' /,��.. ��f �; _- �a-� i� �, r _ i .. ��� <br />re � � Date (Revised 6/2012) <br />� � /•;1• <br />