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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 wvvw.everettwa.org <br />ADDRESS: <br />for new cortstruction: Short PlaUsul <br />t <br />Owner _ Owner's Agent _ Contractor <br />PROPERTY Tl�X # <br />No. <br />i "1 .� <br />(attach copy of long legal description) <br />Phone/E-mail <br />City/State/Zip <br />Contractor's Agent g T0f18�i (must provide a letter of consent from ihe avnerto do work in llie <br />State Lic. # Citv Bus. Lic. # <br />�Phone/Email <br />ACT FOR PERMIT <br />- IlCt�t �,z��ht� C� <br />Phone/E-m <br />BUILDING PERMIT APPLICATION CONTRA <br />F�cisting Use of Buiiding ----�_.;-�--_------, <br />Proposed Use of Building_____;__._ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family <br />Type of project: _ New Addition Remodel Repair ��M�``�T.I. <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New_Addn _Alteration _Repair <br />Show Num6er (#) of fixtures <br />i A/C—airhandlingunits <br />Forced air systems <br />Gas piping <br />' Water heater <br />PRICE OF WORK <br />HEAT SOURCE: <br />Gas_ Electric Other <br />�, — — <br />_ Commercial <br />n Sarinkler Demolition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn _Qlteration ^Repair <br />Show Number (#J of �xtures <br />i Toilet <br />Gas fire lace I Kitchen sink & dis osal <br />Gas ran e Dishwasher <br />Clothes dr er Clothes washer <br />' Ran e hood Water heater <br />Exhaust fan Sink servicelbar/mo /etc. <br />Heat um I Backflow reventer inside bld <br />Unit heater Urinal <br />Boiler Drinki Fountain <br />Refri eration Floor drain <br />Woodstove Grease tra <br />Ductin Roof drains <br />'; Other Medica( Gas <br />SPRINKLER / SUPPRESSION SYSTEM other: <br />! Number of Heads Other. <br />I hereby certify that I have read n examined this app icatfon and knowthe same to be true and correct. All provisions of laws and ordinances goveming this type ofwork wi(I be compl <br />wdh whether specified herein r t. The granti a perm ot presume to give authority to violate orcancel the provlsfon of any other state or local law regulating construction <br />That I a autt�aria�i�r�f this or orm th rk for which applicatfon Is made and I comply wdh the State Contractors Law 1827 RCW and 296200A WAC. <br />F / G te ���/ ��� �—/�'�(R�rs�015) <br />l <br />�L <br />