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� <br />� <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 />ITE ADDRESS: �S 2!Q O�KES �V� �OS�� �1�� Iq n Z.�vV �PI �OJ � OI � <br />� <br />EGAL for new construction: Short PlaUsubdivision <br />�NER VHV 1 D <br />Iress `SZ � � <br />PLICANT: Owner <br />�NTRACTOR <br />No. (attach copy of long legal description) <br />5 Phone/E-mail <br />� v � City/State/Zip v��/ <br />Own2�'s Agent _ Contractor _ Contractor'S A9@fll _ TE(1Bfli (must provide a letter of consent from the owner to do work in the space) <br />L 8� I Lic. # COE Bus. Lic. # <br />Phone/Email <br />I CIVNIV 1 CUJIIVCJJ IVHIYIC l.}JIVi� l.l rVK����� ^��� ���1����� <br />� 1� � %��/ <br />Phone/E-mail — <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building � � <br />Proposed Use of Building � r C � <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New _ Addition �� Remodel _ Repair _ T.I. _ Sign _Sprinkle <br />DESCRIPTION OF WORK (additiona� space provided on tne back) : <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn ,�Alteration _Repair <br />Show Number (#J of fixtures <br />A/C — air handlinq units <br />Gas fireplac <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />� SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />� Electric Other <br />Demolition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New �Addn _Alteration _Repair <br />Show Number (#) of �xtures <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dispos <br />Dishwasher <br />Clothes washer <br />Sink (ser <br />Backflow <br />Urinal <br />rioor arain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify Ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this rype of work will be complied <br />with whether specifed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other stale or local law regulating construction <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� � <br />�,. <br />%� i <br />�,- � „� ���z %( �'%s' Z- <br />wner/Authorized gent Signature Dat (Revised 6/2012) <br />