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�ERMIT APPLICATI <br />O <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 />SITE ADDRESS f,�,, �.` � <br />�7i �;` /r' � /��' �`� > t'' ��f ��� �, l/>-� <br />�. , <br />LEGAL for new construction: Short Plat/subdivision <br />OWNER E'!��/�E�� /1O!/S%/��� i%�T�/�/�•/, <br />Address �/d � [—QL_�i �v� � <br />CANT: V Owner <br />ONTRACTOR <br />ER�TAXkt I PEf�AIT# <br />%:3i?C_L�/ l <�;,;, r> �� �`%( � <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail ��,� ' G �,� / � L � <br />City/State/Zip �(����� �/� <br />' %i �a- <br />Owner's Agent _ Contractor _ Contractor�S ACJ@flt _ T@fl8�t (must provide a letlef of consent from lhe owner to do work In the space) <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email � <br />Citv Bus. Lic. # <br />CONTACT FOR PERMIT�� I � ^/� �. `� " <br />�� / v <br />Phone/E-mail 7 � �.=> �� 6.���c� /���/������/�' ���'� <br />CONTRACT PRICE OF WORK �.> %�. ��� <br />Existing Use of Building <br />Proposed Use of Buiiding Gas <br />Building type: _ Single Family Dupl '�' T��� ! ulti-Family _ Commercial <br />Type of project: _ New Addition Remodel Repair�� T.I. _ Sign _Sprinkler _De <br />DESCRIPTION OF WORK (additional space provided on the back) : / <br />%�,•�/r��i- ��/! i'����.� C i y',�,� ��i-/ /�✓U <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 />j Gas piping <br />Water heater <br />� Gas fireplace <br />f Gas range <br />� Clothes dryer <br />� Range hood <br />Exhaust fan <br />Heat pump <br />� Unit heater <br />Boiler <br />� Woodstove <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSIO <br />Number of Heads <br />TEM <br />HEAT SOURC : <br />Electric � Other <br />molition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />pe 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 />I Backflow oreventer <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 slate or local law regulating construction <br />That I am ut rized 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 />� � � � t� <br />Owner/Au�i�'pri�d Agent Signature <br />_!� _/ <br />Date <br />(Revised 3/2013) <br />