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• <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />E ADDRESS: � y�D}' PROPERTY TAX # PERMIT #. <br />�� �`i � C;AS i••rv Ec- ei � lJ' �' � ��- Gvp� n/1 � 2U �- C.� �� <br />for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br />ER ,,,) a N �+ 13L1� �., j S <br />380 �� �i3 R�1 ;�r <br />NTRACTOR <br />�s G���l� v�s <br />BUILDING PERMIT APPLICATION <br />Phone/E-mail <br />E1 C4 �' hts�,.d �City/State/Zip <br />L & I Lic. # <br />Phone/Email <br />I+VIVIHIiI rVRrCR1Vll1 <br />�'�'�t �� f1z �;�,� a� c3E�� �a�- y�� ct.�' <br />Phone/E-mail ( y3ri 3SS� S'� �c <br />CONTRACT PRICE OF WORK �(; C)C; U�, <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Eiectric_ 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 Wofk (additional space provided on the back) : <br />� !J S � y� � �iI � Ouc� • <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PE RMIT APPLICATION <br />pe of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />fvc; — air nanaiing u <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas range <br />Clothes dr <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />I Toilet <br />I Bathtub <br />sh basin <br />Shower <br />Kitchen sink & disp <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <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 examined 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 pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />"��.� %�.�ZtiGvf � � f 'a i'" � d"' <br />Owner/Authorized gent Signature Date (Revised 2/2011) <br />