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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: (y l� PROPERTY TAX # PERMIT # <br />33 i z U;r_ �-w=.yY A-cl� �--U �ti\/ I i Z�lc I -,L -c <br />=GAL for new construction: Short Plat/subdivision �� Lot No. (attach copy of Iong legal description) <br />i <br />WNER��n,v�.'C j--}t�v'� C; o��� Phone/E-mail C L'�c �`� � /�� L <br />idress � � S � � /1�l _. i 2�,�r"'YI �i1 /l f-c� J� ,� �� City/StatelZiP ► `� ��.1�..^-t'7� � � � �� ��'�( � � �7 <br />NTRACTOR +,_ ,,.�.c.= <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building <br />L&ILic.# <br />Phone/Email <br />Phone/E-mai I <br />CONTRACT PRICE OF WORK <br />HEAT SOURCE: <br />Proposed Use of Building � Gas_ Electric_ other <br />Building type: _ Single Family _ Duplex _Townhou,J�� e�,�— Muiti-Family _ Commercial <br />Type of project: _ New _ Addition _ Remodel _"`f�p�ir _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DesCription.of Wo�k (additional sparce provided on the backJ : / ���, � __ � , y.� <br />�_. i,�� c% < j cc� �e: l''-�r...�, 2_ 2 ��' c• �� ��. 'C c� z. f' � 7�- . 4i �, ?�� �.-, c r' �; �� J <br />/'`c.v,�i� � d �c�,,,t:rC r�(-�u /.�c,-f� r}/�-�2 7,z(.� u l� jP��.:��a'�( ���� ���� j ��e (�(, <br />1! I ( r'� f� L"f\ 1' ('-*" �� f _"_'. t � J � I <br />( <br />Have you started working without a permit7 _YES _NO 1 �� uv" �� �� �=� � f- f i`�. �� S r <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />) A/C — air handling units <br />1 Forced air systems <br />� Gas pipinq <br />vvater neater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Bathtub <br />h basin <br />Shower <br />Kitchen sink & dispo <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mo <br />Backflow preventer <br />Urinal <br />Drinkinq Fountain <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 know 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 Iocal law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />f to perform the ork for which application is made and I comply with the tate Contractors Law 18.27 RCW and 296.200 WAC <br />�, , . . <br />_-., <br />_. _ � — -- <br />_.__�.. , � <br />1 , � <br />"�} OGiner/Authorized Agent SignatUre '" Date (Revised 2/2011) , <br />�i <br />