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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 />ADDRESS: .� s PROPERTY TAX # PERMIT # � <br />�;� i-�J G�; R� �� t- GZ� <br />LEGAL for new construction: Short PlaUsubdi� <br />OWNER I�p(_��') SC1�� �c:;� <br />Address �j � � � ��= � < < <br />APPLICANT: _ Owner _ Owner's Agent <br />CONTRACTOR (� L-�� ��;,';�1 �, <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail <br />City/StatelZip <br />Contractor _ Contractor�S A9@I1I _ TBflBflt (must provide a letter of consent from lhe owner to do work in the space) <br />`l � L& I Lic. #;L COE Bus. Lic. # <br />,,� (j�,j,�,Q j j jL y„ ��j;���� � Phone/Email <br />Phone/E-mail � �f2 —S�.s'I U a f-�� ,�'/ , <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Eiectric other <br />Building type� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : � • / / / 7 <br />i`��l�1nL�✓�I�•� SiVi�C.�., r�—�PI�G�'V:,�;ti(��1 ���/,�'j+/7Li/�. <br />j��,F. <br />MECHANICAL PERMIT 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 piping <br />Water heater <br />� Gas fireplace <br />� Gas range <br />Clothes drver <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriaeration <br />� Ducting <br />j Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />� Lavatorv (wash basinl <br />Shower <br />Kitchen sink & d <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 know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authori 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 />V � (' ��i <br />Owner/Authori ed Agent Signatu �ate (Revised 6/2012) <br />