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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 '��" o-((��
<br />SITE ADDRESS: I
<br />PROPERTYTA ri ; � i ��
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<br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br />OWNER � '','^�"� � i i �r'r�j'�,�,„ti^\ Phone/E-mail
<br />4ddress - ` — =� �! _ ' City/State/Zip � . r+ �`
<br />4PPLICANT: _ Owner _ Owner's Agent � Contractor _ Contractor's Agent _ Tenant �must p�ovide iene o nsent from the owner to dowork in the space)
<br />�ONTRACTOR � ' ���"' � ,`� �( , . �r i'�� ' t- � L & I Lic. # ���V`� !,�� :. t � �_� � _ ,�� COE Bus. Lic. # ' ;� ���
<br />address �.. ���'..� ; �� � ���, ._ ��v t"� _��iE � .. Phone/Email t�,�r ���"�i,f � .. 1 �
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<br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK _ � F Z-, (�" ��-t, 1 2
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<br />Existing Use of Building �>� ��"� v ��_1'1^, I i�. iti'v t��r�� �-(`',? HEAT SOURCE:
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<br />Proposed Use of Building �,�ilC t� �� �`- i�� �d'��� �,� �<i i)�i: Gas_ Electric ',� Other
<br />Building type: �, Single Family _ Duplex _�`ownhouse _ Multi-Family _ Commercial
<br />Type of project: _ New _ Addition _ Remodel �' Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use
<br />DESCRIPTION OF WORK (additional space provided on the back): �� 'fj'���/� fi� ��- �'C�(,� ` J�,t �'j� (��M�*y�
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<br />MECHANICAL PERMIT APPLICATION PLUMBING PER IT APPLICATION
<br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration �< Repair
<br />Show Number (#) of fixtures Show Number (#) of fixtures
<br />A/C - air handling units � Toilet
<br />Forced air svstems Bathtub
<br />Gas piping
<br />Water heatf
<br />Gas fireplac
<br />Gas range
<br />Clothes dry�
<br />Range hooc
<br />Exhaustfan
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<br />Lavatory (wash basin)
<br />Shower
<br />Kitchen sink & disposal
<br />Dishwasher
<br />Clothes washer
<br />Water heater
<br />Sink (service/barlmop/e
<br />Backflow preventer
<br />Unit heater Urinal
<br />Boiler Drinking Fountain
<br />j Refrigeration Floor drain
<br />Woodstove Grease trap
<br />Ducting Roof drains
<br />Other Medical Gas
<br />SPRINKLER / SUPPRESSION SYSTEM Other:
<br />Number of Heads Other:
<br />I hereby certrfy that I have read and examined this application and know lhe same to be true and correct. All provisions of laws and ordinances goveming lhis 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 consiruction
<br />That I am aut orized by the owner of lhis property to perform lhe work for which application is made and I comply with the Stale Contractors Law'18,27 RCW and 296.200A WAC.
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<br />Owner/Authorized ent Sign ure Da e (Revised 6/2012)
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