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PERMIT APPLICATION <br />BUILDING/MIECHANICAL/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 />SITE ADDRESS: , PROPERTY TAX # PERMIT # <br />���`� �����--� P►3n`�-�S <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER Ghj'�j �� ��, e(� � 1.t1�� /'� Phone/E-mail <br />�SS �,zz� vu�m�or� <br />LICANT: _ Owner _ Owner's Agent <br />ITRACTOR ,�/� ��IA41n�� v1 <br />"(/� City/State/Zip ��(� ji �$�Q <br />Contractor _ Contractor�S A98f1t _ TBf18f1i (must provide a letter of consent from the owner to do work in the space) <br />L&ILic.# <br />Phone/Email <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of �uilding G� <br />Building type: '� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel � Repair _ T.I. _ Sign _Sprinkler _C <br />DESCRIPTION OF WORI'� (additional space provided on the back) : <br />MECHANICAL PE RMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas pipinc7 <br />Gas fireplace <br />Gas ranae <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Wcodstove <br />Ducting <br />STEM <br />Number of Heads <br />COE Bus. Lic. # <br />ZS • <br />HEAT SOURCE: <br />_ Electric _ Other <br />molition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Numbei (#1 of fixtures <br />Bathtub <br />basin <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 />otner: 5Q � <br />Other: <br />I hereby certify thal I have read and examined lhis application and know the same to be true and correct. All provisions of laws and ordinances goveming ihis type of work will be complied <br />with whether specified herein or not. ihe granting of a permit does not presume to give authority to violate or cancel lhe provision of any other slale or local law regulating consiruction <br />That I am authorized by the owner of lhis property to perform the work forwhich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized Agent Signature Date (Revised 6/2012) <br />