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� TI �
<br />PERMIT APPLICA 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 />APPLICATIONS ARE ACCEPTED F�OM 8� AM TO 4 PM
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<br />' � PROPERTY TAX #1 �_ PE�% IT #//� i., �,
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<br />LEGAL for new construction: Short PlaUsubdivision � ��', t" ,�l.;,T_Lot No.� � `(attach copy of long legal description) �' "-'� � � 4�
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<br />OWNER,~S, -\ t-'., � c ` C, �- Phone/E-mail 1 � .,� ,. �: � , _ � � > '�
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<br />City/State/Zip � `- ,
<br />Address'•.,t �\"^ �l\`-�� ,� < �c , . . �\. `,. .,_,r _ �� ��, L �
<br />CONTRACTOR r7 L& I Lic. #
<br />Address Phone/Email
<br />TENANT BUSINESS NAME CONTACT FOR PERMIT � � yZ5-}�-��f --�
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<br />Phone/E-mail `� ' ��. � t--_` . �_` , �-
<br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK j 2,� Uv(�
<br />Existing Use of Building � � .- �� ,��� . _ . HEAT SOURCE:
<br />Proposed Use of Building :���. . � Gas_ Electric •, 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 />DeSCrlption of WOrk (additional space provided on fhe back) : � � ,�,, l�� �� y ;� ; ,` ,� -�<�; � � 5 � � `a�. �.:':;: ,� , .. , •.;\ �
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<br />Have you started working without a permit? _YES _NO
<br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br />Show Number (#) of fixtures Show Number (#) of fixtures
<br />� A/C — air handling units �_ Toilet
<br />Forced air systems �„�_ Bathtub
<br />Gas piping � � Lavatory (wash basin)
<br />Water heater Shower
<br />Gas fireplace Kitchen sink & disposal
<br />Gas range � Dishwasher
<br />Clothes dryer � Clothes washer
<br />1_ Range hood Water heater
<br />L_ Exhaust fan Sink (service/bar/mop/etc.)
<br />Heat pump Backflow preventer
<br />Unit heater Urinal
<br />� Boiler Drinking Fountain
<br />Refrigeration Floor drain
<br />Woodstove Grease trap
<br />Ducting Roof drains
<br />Other � Medical Gas
<br />SPRINKLER / SUPPRESSION SYSTEM Other
<br />Number of Heads
<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
<br />this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel
<br />the provision of any other state or Iocal law regulating construction or the performance of construction. That I am authorized by the owner of this property
<br />to perform the work for which application is rrtade �nd I cp�nply with the State Contractors Law 18.27 RCW and 296.200 WAC
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<br />Owr���Ai1t#�o�'¢ Agent Signature �._.� Date (Revised 12/2010)
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