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� <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMO�.ITION <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 />ITE ADDRESS: PROPERTY TAX # PERMIT # <br />ID�� <�l�c.�o ��,��u� E��l �ff i�L�i�'����`fiC�j3 �",1�) � 31 D-�n <br />for new construction: Short Plat/subdivision <br />OWNER � <br />Address � � <br />CONTRACTOR <br />ress <br />BUILDING PERMIT APPLICATION <br />Lot No. (attach copy of long legal description) <br />Phone/E-mailL�,�S-jZlp}�Jj25 �)y �'(�L�."sL�j v�.sy� <br />City/StatelZip �V��1�� �:V f} ��f �(,)� <br />L&ILic.# <br />Phone/Email <br />CONTACT FOR PERMIT /�„��`p ��G��r. ��� <br />l� T <br />Phone/E-mail ,� �'�j- � `j�Z � ' �(,t,t -• �u�LK.�h �' ['s� C�'�. ►'�� <br />CONTRACT PRICE OF WORK � :� �O -OD <br />Existing Use of Building j,�(iQ�t_CYLi.7�G � ���w� �/,+'Ll.% HEAT SOURCE: <br />1 /� �� /_� <br />Proposed Use of Building �_ ` �./ �l/ � Gas Electric_ other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ PJew _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />Description of Wofk (additional space provided on the 6ack) : <br />,L��,�v�`�-r�1,i. � u� htcf�l� I-�� � . . _ �F�2ov S P����,,,,�,. <br />Have you started working without a permit? _YES �NO �` ���2� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair � i�.B/vt�,�L <br />Show Number (#J of fixiures Show Number (#) of fixtures <br />A/C - air handling units ��a. � � �iToilet <br />j Forced air systems 1 j Bathtub <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeration <br />� Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <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 krow 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 �hjch appliGation is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />� <br />-�: �tit�,: , �-�,,,, ,%'2� i'3 <br />_ , �:�`� ��� <br />Owner/Authorized Agen Signature Date (Revised 2'2011) <br />�/ <br />Z <br />