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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 />�DDRES,$� �. 1 � . e , ,� /'1 I � � PROPERTY TAX it ����I� (� I�ry- <br />for new construction: Short Plat/subdivision <br />NER <br />NTRACTOR �,�j �L/� �j <br />ress� I � � ���' �/ � V � <br />VANT BUSINESS NAME <br />BUILDING PERMIT APPLICATION <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail �(! � � 4i �� —� �1 � � <br />City/State/Zip �� ��� V t/ �" ���U <br />L&ILic.# � �Z � � � <br />Phone/Email � � S � � ( <br />ne/E-mail �- t�l I G� v« <br />NTRACT PRICE OF WORK <br />- � � �- <br />��-�- v� i <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of 8uilding Gas � Eieccric other <br />Building type: Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of projec :_ New _ Addition _ Remodel � Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />Desc�ription of Work (additional space provided on the 6ack) : <br />l�1 �' �'n _ 1G a� �� j=t/�tn �� (:� G i.-`.�„�,,�� � c.a t- <br />� <br />Have you started working without a permit? YES _NO <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn�Alteration _Repair <br />Show Number (#) of fixtures <br />A/C – air handling units <br />Forced air systems <br />Gas piping <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 />Hetrigeratfon <br />W oodstove <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />� <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavator (wash basin) <br />Shower <br />Kitchen sink & dis osal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <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 true and correct. All provisions of Iaws and ordinances governing <br />this type of work wili 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 provis%i n 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 � rfor�tS-the w for whiG�i applicatiQn is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />� ��' �2 l � 1 I � <br />Owner/Aut onze gent Signature � Date (Revised 2/2011) <br />