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�.I <br />� <br />PERMIT APPLICATION <br />BUILDING/ME�HANICAL/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 />SITE ADDRESS: PROPERTY TAX q PERMIT # <br />;� ,,,�; x,-✓� rz�-r� a��;,�� <br />LEGAL for new construction: Short I'lat/subdivision Lot No. (attach copy of long legal description) <br />OWNER !''N� � l�i �`T Phone/E-mail ?{'1�l ��c<Zi�' �1�i1:rt,:; �I Cc , �-i <br />Address �25'SG � `SI„� `T :"� City/State/Zip Cl/�-�<< �� ��/� `�$-ZO;� <br />ONTRACTOR <br />�1'1 �<� � � <br />iress r �_ "1 � <br />NANT BUSINESS NAME <br />BUILDING PERMIT APIPLICATION <br />L&ILic.# <br />Phone/Email <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building oi7� HEAT SOURCE: <br />Proposed Use of Building ���`- Gas Electric Other � <br />Building type: >C Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New _ Acldition � Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />Description of Work (additional space provided on the back) : <br />j'G:,�; ,_ z__ <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) vf fixtures <br />� A/C — a r handling units <br />Forced air systems <br />� Gas piping <br />Water heater <br />I Gas fireplace <br />Clothes drye <br />Ranae fiood <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodsb�ve <br />SPRINKLER / SUPIPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />02 ! I Toilet <br />� Bathtub <br />� Lavatory (wash basin) <br />' Shower <br />� <br />; Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />� Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and e�:amined this application and know the same to be true and correct. All 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 />/—G�L r"� %Lc..�-c� � �� % .�— <br />Owner/Authorized Agent Signature Date (Revised 2/201 i) <br />