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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 />SITE ADDRESS: . � � PROPERTY TAX # R I�
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<br />LEGAL for new construction: Short Plat/subdivision_ __________________________Lot No.___ _(attach copy of long legal description)
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<br />CONTRACTOR ��'— , � �, f ,�; i• �� i ��;:�; E t.'. ; ;'� L & I Lic # r:'-. {�'' i ,� - j' "`' ,-�
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<br />TENANT BUSINESS NAME CONTACT FOR PERMIT �
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<br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK"'� �-`F �"_s________
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<br />Existing Use of Building _ HEAT SOURCE:
<br />Proposed Use of Building_________________________________________ Gas____ Electric____ Other
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<br />Building type: ___ Single Family ___ Du lex ___Townhouse �`�
<br />p ___ Multi-Family _�� Commercial
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<br />Type of project: __ New ___ Addition ___ Remodel ___ Repair ___ T.I. �`- Sign __Sprinkler ___Demolition___Change of Use
<br />Description of Work (add�tional space prourded on the back): �,-,
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<br />Have you started working without a permit? ____YES ."���NO
<br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br />Type of Project: ___New ___Addn __ Alteration ___ Repair Type of Project: _ _New ___Addn ___Alteration _ _Repair
<br />Show Number (#) of fiztures Show Number (#) of fixtures
<br />A/C — air handling units Toilet
<br />Forced air systems � Bathtub
<br />Gas piping k Lavatory (wash basin)
<br />" Water heater ; Shower
<br />Gas fireplace Kitchen sink & disposal
<br />'� Gas range i ' Dishwasher
<br />! Clothes dryer Clothes washer
<br />Range hood Water heater
<br />° j Exhaust fan ; Sink (service/bar/mop/etc.)
<br />5. Heat pump Backflow preventer
<br />I Unit heater '; Urinal
<br />"3 ' Boiler ' Drinking Fountain
<br />� Refrigeration ! Floor drain
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<br />Woodstove Grease trap
<br />Ducting '�, Roof drains
<br />Other________________ �; , Medical Gas
<br />SPRINKLER / SUPPRESSION SYSTEM ' Other.
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<br />Number of Heads 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 th work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC
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<br />Owner/AutHorized•Rgent Signature ` -DaZe( � ' (Revised 2/2011J
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