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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 />ADDRESS: <br />TAX # <br />�i.l - �C) <br />for new construction: Short PlaUsubdivision Lot No.�Q (attach copy of long legal description) <br />c <br />Phone/E-mail LU(o' "a( (io' <br />c�riistaterz�P 5►�n�,rsw <br />LICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant (mu� pro�de a iener awnsent vom u,e owner �o do worx �n u,a spa�� <br />CONTRACTOR � � � � � � � � � <br />state Lic. # dC <br />Phone/Emaii . <br />CONTA T FOR PERMIT <br />PhonelE-mail <br />Bus. Lic. # <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building 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 />DESCRiPTION OF WORK (additional space provided on the back) : �U r �n� � � ���, / �n �G � ( <br />��l <br />��` � 1'� (,� ��� �..�`"'�"� ��Y'� �`%�t'�i-�,Y� �' � I.� m � <br />, <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fxtures <br />A/C — air handling units <br />I Forced air systems <br />Water heater <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />SPRINKLER / SUPPRESSION <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />basi <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Sink <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 applica6on and know the same to be true and correct. All provisions of Iaws and ordinances goveming this type of work will be complied <br />with whether spec�ed 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 reguiating construction <br />That i am authorized by the owner of this property to pertorm the work for which application fs made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�.���� - <br />� � �l7-/� <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />rn <br />