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� <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLEF:/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 v�rww.everettwa.org <br />SITE ADDRESS: <br />,��� �� ;� <br />PROPERTY TAX # <br />�v /r��, <br />PERMIT #. _ <br />uly��1"U <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />Phone/E-mail <br />� <br />PPLICANT: _ Owner _ Owner's Agent �Contractor _ Contractor�S Ageflf _ T011alit (must provide a letter of consent from the owner to do work in the space) <br />ONTRACTOR �^ , �j^ ; State Lic. # /�%/% � Q� /U(� City Bus. Lic. # <br />idress � ,��wo �� � 't �� PhonelEmail d r�� �� ��!� <br />�NANT BUSINESS NAME CON CT FOR P M T Z <br />��r ��� ` � <br />/GTi/Ii��i �i�� ��//i'� Phone/D I �r��v �����i/it:�a!✓J�u� r�. <br />BUIL�ING PERMIT APPLICATION <br />Existing Use of Building GGtPi�CR <br />Proposed Use of Building /��U%L� <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family <br />Type of project: New Addition � Remodel Repair _ T.I. <br />DESCRIPTION OF WORK (additional space provided on the back) : <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 fireplac <br />Gas range <br />Clothes dryE <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />� KetngeraUon <br />I Woodstove <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� � Number of Heads <br />PRICE OF WORK <br />Ga <br />Commercial <br />�prinkler C <br />evLX s.�o <br />HEAT SOURCE: <br />=E:lectric_ Other_ <br />olition Change of Use <br />PLUMBING PERM11� APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />! Toilet <br />! Bathtub <br />j 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 />I Urinal <br />j Drinking Fountain <br />I Floor drain <br />Grease trap <br />I Roof drains <br />i Medical Gas <br />i 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 auth rized by the owner of this propeRy to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />i n.� r / � <br />O ner/ uthorized Agent Signature Date (Revised 3/2013) <br />