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• <br />• <br />PERMIT APPLICATION <br />BUILDINGIMECHANICAL/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 />ITE ADDRESS: � PROPERTY TAX # � � � n,� , PERMIT # <br />i�'UL �-r' 1�� S�� �1�'�r;�►► i, ��,LC�c�b%r.�o? ��c�V,c I� i�i �—U I� <br />EGAL for new construction: Short Plat/subdivision Lot No <br />�WNER ;��i���.) i..I1N�i f�►i:J�l���,� Phone/E-mail <br />ldress z2 � �, �� ��� �1� ��U, �ru����U�� CitylState/Zip <br />PPLICANT: _ Owner �y� Owner's Agent _ Contractor _ Contractor's Agent <br />TOR <br />ress <br />5���'��d� �'�'���,l.ifl9e��u�- <br />BUILDING PERMIT APPLICATION <br />L&ILic.# <br />(attach copy of long legal description) <br />_� <br />: �� � i . �' � ,1'1 � ✓, <br />� <br />T0�3IlY (must provide a lolter of cun5onf (roni the owniir to do work In the space) <br />PhonelEmail <br />COE Bus. Lic. # <br />�'����. i�'�tic,����'r1i.�� �,�,�? <br />ne/E-mail <br />NTRACT PRICE OF WORK � I�"a _ <br />Existing Use of Building l� +��J1N�:1� � <br />n .. � <br />Proposed Use of Building ) ��, )j�C;�� <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 (addrtiona! spa�e provided on the back) : <br />��;c�; �,�,���d�f ��u.i�1 � � f2u�' �c�,�;, 9�;fr ,t'�G� .�:�'.��- II�,�I �1j.��':�'ti.115F. <br />(V'U�,' �i��'�i" I,y'il�':); �Gw�'� Gilt�u a'�� N,J�t1��u.�l�L�� �� ��G,'l',�'i './ <br />MECHANICAL PERMIT APPLICATION <br />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 ranqe <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />�frigeration <br />oodstove <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />as Electric Other_ <br />Demolition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />I Bathtub <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dispos <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/moK <br />Backflow oreventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof dra ns <br />Medical Gas <br />Other: <br />Other: <br />I hereby c:ertify that I have read and ezamined this appiication and know the same to be true and correct. All provisions of laws and ordinances governinq this type of work will be complied <br />with whether sp ifj�d herein or n T nting of a permit does r.ot presume to give authority to violate or cancel the provision of any other state or local iaw regulating construction <br />That I am auth' ze� he o e'o t� pr peRy to perform Ihe work for which application is made and I comply with [he State Contractor Law 1827 RCW and 296.200A WAC. <br />1 lu /^ .! ; � �( � <br />ier/Aut�jori�d44�krtt,�i��re Date (Revised 6/2012) <br />� � � ` � �7 <br />�� �! <br />