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PERMIT APPLlCATION <br />�UILDING/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 />SITE ADDRE[S,S: �' PROPERTY TAX # PERMIT # <br />i Ll� 7-/�.�.� L/�'1 G� C- �� �S� �' �-� �' �,� <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long Iegal description) <br />�` /�/ r <br />OWNER - � y ' � N'C PhonelE-mail � . — S I '/,�G' (—'�f--`,G- 7'�iJ�' _?'�+ ! <br />�e <br />Address 1� �,� /�y �C /�q/ d /� l✓ t� CitylState/Zip % v' f-' �1C Fl.� .. %"I r %� L.� 4� <br />CONTRACTOR /� � V; N /" �.c� C SJ ti �,i� L& I Lic. # <br />BUILDING PERMIT APPLICATION <br />Phone/Email <br />FOR PERMIT <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric_ Other_ <br />Building type: _�j,ngle Family plex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New _ Addition ��temodel _ Repair _ T.I. _ Sign _Sprinkler _Demclition_Change of Use <br />DesCfipti0n Of WOfk (additional space provided on the back) : � <br />:t. . � � % + . !''- j.. � r '�' ' <br />.. ' � � : ,. . �_i- i �� ;�-, . . _ '` , ' <br />Have you started working without a permit? _YES �\�NO� ^. �� ' c '� � <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of /ixtures <br />� A/C — air handling units <br />� 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 />Refrigeration <br />Woodstove <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fiatures <br />I � Toilet <br />� f Bathtub <br />( / Lavatory (wash basin) <br />Kitchen sink & disposal <br />Dishwasher <br />Ciothes washer <br />Water heater <br />Sink (service/bar/mop/e <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 lne same to be true and correct. All provisions of laws and ordinances governiny <br />this type of work will be complied with whether specified herein or not. Th.. grant ing c F a rermit does not presume to give authority to violate or cancel <br />the provision of any other state or local law regulating construction or th�; pertormance of coristruction. That I am authorized by the owner of this property <br />to oe rrrr�the wor�for whic�application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />r�i <br />�yL-�' � i L�/Cr�.� '"�' � G_/'�—, <br />"er/Authorized A ent Signature Date (Revised 2/2011) <br />� "` 1/�-a' ` ` <br />t <br />