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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 />E ADDRESS: ,� � _,._, , „ PROPERTY TAX # P�RMIT # <br />LEGAL for new construction: Short Plat/subdivi <br />ER <br />C_' <br />ress '��;`r2 l,�'l�!�i i��'i 1�7 ([, �"� l%f <br />�LICANT: Owner Owner's Agent _ Contractor <br />CONTRACTOR �J�� <br />��� <br />Address �"�; �� � <br />�i `� �'.Ei `� ��1 / 7L'� � - � <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail J�� �'`� �� � �. �� � <br />Lry � <br />City/State/Zip � �r 7, � <br />CO�IfBCtOf 5 F�g@fli _ T2f10f1i (must provide a letter of consen� Gom �he owner [u do wark In �he sp2ce) <br />% l.i L& I Lic. # COE Bus. Lic. # <br />qrJ , Phone/Email ����� <br />CONTACT FOR PERMIT „—�� <br />Phone/E-mail �'��% � � � ,� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. Sign Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />�f�C�C l.t%` ��� � �L ��G�( �m,� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <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 />' Refrigeration <br />Woodstove <br />' Ducting <br />' Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />' Number of Heads <br />�ySh��`��' <br />HEAT SOURCE: <br />Gas �jr Electric Other <br />emolition Chanqe of Use <br />PLUMBIiNG PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <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 know the same to be Uue and correcL All provisions of laws and ordinances governing this type of work will be complied <br />with whether specifed herein or nol The granling of a permit does not presume lo give authority to violale or cancel the provision of any other slate 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 Slate Contractors Law 1827 RCW and 296.200A WAC. <br />' ---- —, � o� � <br />� <br />� � <br />� _. ._ � <br />Owner/Au4horized Agent Signat,yr� Date � (Revised 6/2012J <br />��,j J .�. - <br />�� <br />