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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 />ITE ADDRESS: <br />LEGAL for new construction: Short PlaUsubdivisio <br />OWNER <br />PPLICANT: � Owner _ Owner's Agent <br />ONTRACTOR <br />PERTY TAX # <br />P MIT # <br />� l�l� ��D <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail �1 / \ "' � /� ��l�7tJ <br />Contractor _ Contractor�5 A92fll _ TBflafl� (must provide a letter of consent from the owner lo do work in the space) <br />State Lic. # City Bus. Lic. # <br />�Phone/Email <br />ACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building Ga <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _C <br />DESCRIPTION OF WORK (ad ional space provided on the ba k): <br />N�' �,� (L-DD�`` tN.�r�► �-�-�'»� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />I Forced air systems <br />� Gas piping <br />HEAT SOURCE: <br />Change of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (�) of fixtures <br />� Toilet <br />I Bathtub <br />basi <br />Water heater j Shower <br />Gas fireplace j Kitchen sink & disposal <br />j Gas range j Dishwasher <br />; Clothes dryer I Clothes washer <br />Range hood ; Water heater <br />� Exhaust fan � Sink (service/bar/mop/etc.) <br />� Heat pump I Backflow preventer <br />� Unit heater i Urinal <br />; Boiler Drinking Fountain <br />I. Refrigeration ; Floor drain <br />Woodstove ; Grease trap <br />Ducting j Roof drains <br />� Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM I Other: <br />Number of Heads i Other: <br />I hereby certi(y that I have read and examined lhis 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 not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other stale or local law regulating construction <br />That I am authorized by the owner of this propeRy to peRorm lhe work (or which application is made and I comply with the State Contractors Law 18 27 RCW and 296.200A WAC. <br />�'�%r..���1�,r,r;� �l3 l�1 � <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />