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�RMIT APPLICATIO <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 />_.�. ._ <br />�: .� i I 5 i� i C T� ��' �.�v���� T" w� ....._ <br />_ 1 J f <br />:GAL for new construction: Short PlaUsubdivision ,�'`� Lot No. (attach copy of long legal description) <br />NNER ^ ( �j / /� /�� lT (�/� Phone/E-mail � ys �i � � 5 G, �,� <br />dress I �j (� �j �� (, /-� /�/ �� � (� City/State/Zip �G �/C�I� E-f � ��� �� � Z o j <br />NTRACTOR �� ilt�lll �, 2, <br />BUILDING PERMIT APPLICATION <br />L & I Lic. # <br />IPhone/Email <br />CONTACT /FrOR PERMIT <br />�l�i � �`� l� IJ (�.Y l�}- rl-i <br />Phone/E-mail i..�-� � j�f,5 ,� / C� i <br />CONTRACT PRICE OF WORK ��UyQ " :' <br />, <br />Existing Use of Building �� �- S 1/,� El�i � I l`F �- HEAT SOURCE: <br />Proposed Use of Building �� ��' � � r� n S��- Gas_ Electric�C Other_ <br />Building type: ,� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New _ Addition _ Remodel � Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DesCfiption of Work (additional space provided on the back) : <br />�x �1�.�"��.�� s� S <br />Have you started working without a permit? _YES �,NO <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Numbei (#) of fixtures <br />A/C - air handling units <br />Forced air systems <br />Gas oipin4 <br />SPRINKLER <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Ducting <br />Other <br />Number of Heads <br />ON SYSTEM <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dispo� <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mo� <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other <br />I hereby certify that I have read and examined this application and know the same to be true and correct. AII 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 the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />/�� �-%z�-�,�� � �-��..._ �/'i' �/�' i <br />Owner/Authorized Agent Signature Date (Revised 12/2010) <br />