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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 />E ADDRESS: PROPERTY TAX # PERMIT # <br />1'�-�7 01 Z��.s� � G�'l �l'-�( D- Dl� <br />iAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />WNER �I,I��jZ l� <br />idress I ��'� � <br />� <br />DNTRACTOR� (� <br />idress1 L��i�'j `��=��� <br />=NANT BUSINESS N <br />� �� ( � (�_1 . i � .1 <br />Phone/E-mail <br />�''�t5� �G��'-J <br />� L & I Lic. # <br />FSZ�/�- � ' ��� ✓.t'.f�`' ��<L�"� <br />BUILDING PERMIT APPLICATION <br />� <br />� ���� ZL' <br />Phone/Email y1S�7���� <br />R PERMIT��G� JG� ���5 <br />,� —��. ,�-__�-- <br />PRICE OF WORK -?"i�;7i"1 �- <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Fa ily � Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.I. � Sign _Sprinkler _Demolition_Change of Use <br />DesCription of Work (additional space provided on the backJ : I� n(� � f%% ��' �`� ��\ / „\ <br />/ l� �-L � � 1 <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of Fxtures <br />- � A/C - air handling units <br />, I Forced air svstems <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />tion <br />SPRINKLER / SUPPRESSION SYSTEM <br />! Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />� Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash bas <br />Shower <br />Kitchen sink & dispi <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 />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 ovmer of this property <br />to perform the work for v4�hich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />�' � � 4�,� lo a �Y <br />Ow er/Authorized ent Signature Date (Revised 2/2011) <br />