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• • <br />P�RMIT �4�PLICAI'ION <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 />ITE ADDRESS: <br />, <br />L for new construction: Short PlaUsubdivis <br />'NER <br />ress <br />APPLICANT: Owner �( Owner's Agent <br />CONTRACTOR <br />ERTY TAX ti <br />PERMIT # <br />No. (attach copy of long Iegal description) <br />Phone/E-mail <br />ICity/State/Zip <br />Contractor _ Contractor's Agent �TBf18f1Y (musl provide a letter of consenl from the owner lo do work in the space) <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of projecL \ New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinl<ler <br />DESCRIPI ION OF WORK (additiona! space provided on the back) : <br />.� ���,�5'c c���� ;.��" �-,����� '�f'/ -if �� S�, r'�� <br />MECHANICAL PERMIT APPLICATION <br />pe 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 />� Rangehood <br />—� Exhaust fan <br />Unit heater <br />Boiler <br />� Ducting <br />� Other <br />SPRINKLER / SUPPR�SSI�td �l(SYEiVi <br />� Number of Heads <br />Bus. Lic. # <br />HEAT SOURCE: <br />Gas Electric Other_ <br />molition_Change of Use <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />� Lavatory (wash basin) <br />� Shower <br />� Kitchen sink & disposal <br />I Dishwasher <br />i Clothes washer <br />� Water heater <br />� Sink (service/bar/mop/etc.) <br />� Backflow preventer <br />� Urinal <br />j Drinking Fountain <br />� Floor drain <br />Grease trap <br />� Roof drains <br />I Medical Gas <br />I Other: <br />� Other: <br />I nereby certify lhat I have read and examined this application and know the same lo be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner ot this propeRy to perform the work for which application is made and I comply with the Slate Contractors Law 18.27 RCW and 296.200A WAC. <br />'/z <br />l / Z' `� / , <br />Ow rl uthorized gent Signature Dale (Revised 3/2013J <br />