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� � <br />PERMIT APPLICATION <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 FROM 8 AM TO 4 PM <br />TE ADDRESS: PROPERTY TAX # PERMIT # <br />��t �-rh ���- ,cv� 0(�'1 q 24 b 0 c� � I"1 �(� n���� n,.. t� z <br />for new construction: Short Plat/subdivi <br />� T��i v� I� I� I��S� <br />�I -I �-h Sfi S� <br />ONTRACTOR rJ � �Ci <br />idress � � � � �� <br />ENANT BUSINESS NAME <br />St- SW # 1 <br />BUILDING PERMIT APPLICATION <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail �Q ��s � 3 � <br />City/State/Zip r W� 3 <br />L�& I Lic. # /'� � �j � <br />� 1 q�-� Phone/Email � �� l�'' I 3 <br />CONTACT FOR PERMIT � Arn ; L �� �S�l <br />PhonelE-mail �'� la C • <br />CONTRACT PRICE OF WORK �P a, ��i� <br />Existing Use of Building � <br />Proposed Use of Building <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 (additional space provided on the back) : <br />Have you started working without a permit? YES =N0 <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems a <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />� Unit heater <br />Boiler <br />' Refrigeration <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />Other <br />Demolition_Change of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatorv (wash basinl <br />Snower <br />Kitchen sink & disp <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <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 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 local 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 made and I comply with the State Contractors Law 18.27 RCW and 296200 WAC <br />�i���� D 10-�I-I� <br />Owner/Authorized Agent Signature Date (Revised 2/2011) <br />