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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 />ITE �jDDRESS: PROPERTYTAX PERpnIT # <br />� _ r �' !� � i/ �, . � r, � : s�;�. %`�' �.�� (�'�7 � �/ 4` �G �'� � l' 6 7c- G� � I � � i - � � �;� <br />E� <br />EGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />WNER � — Phone/E-mail ��/ "" � %• �/S C; <br />idress � .� � , ; ,� _ City/State/Zip � � � _ �� �� � � <br />PPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor'S A98flt _ T@fl8flt (mustprovidealetterofconsentfromlheovmertodoworkinthespace) <br />ONTRACTOR %� �� L& I Lic. # COE Bus. Lic. # <br />Phone/Email <br />A , ` { / l <br />�Yo��'C /fi�b���l � � i JvJ�%... _�` I ! ._�/' . V' <br />Phone/E-mail � `� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �UL�U — <br />Existing Use of Building S��/Q HEAT SOURCE: <br />Proposed Use of�uilding �`%< Gas_ Electric_ 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 />DESCRIPTIOf`� OF WOR (additional'space provided on the back : / / / Q <br />.�zs �a l� ��� sarr �%�/�o� �:�. Occ %�Si� ki2 �rf � Sh e,B� /'o� � I��cr�-�a►�`--� <br />�-�� L�OS�a � /�00 S';� y' CE o� T T� B�D ��o� �/�� 4��� St°a�.�) <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 (#) o/ fixtures Show Number (#) of fixfures <br />A/C — air handling units Toilet <br />Forced air systems Bathtub <br />Gas pipinq Lavatorv (wash basin) <br />vvater neater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Boiler <br />Woodstove <br />Ductinc7 <br />PRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes w her <br />eater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other. �� e �¢ � <br />Other: <br />I hereby certify that I have read and examined lhis application and know the same to be lrue and correct. All provisions of laws and ordinances governing ihis type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume to give authoriry to violate or cancel the provision of any other state or local law regulating consiruction <br />That I am authorized by the owner of this property to perform the work for which applicalion is made and I comply wilh the State Coniractors Law 18.27 RCW and 296.200A WAC. <br />.� <br />� � - �- � , �. t . -z ,;�.z..� f�� z/� 3 <br />Ownek(Authorized Agent Signature Date (Revised 6/2012) <br />