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<br />PERMIT
<br />APPLICATION
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<br />BUILDING/MECHANICAL/PLUMBING/StGN/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 />ADDRESS: Q � PROPE�,7f'y TAX# PERM�# �1
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<br />�L for new constniction: Short PlaUsubdivision '��''N �: r�:^�� i Lot No. (attach copy of long tegal description)
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<br />�� Owner _ Owner's Agent _ Contractor _ Contractors Agent _ Tenant �m�si P�o��ae a�ner of consem rrom ma owr�er a ao w«x m mB SPaoe>
<br />o'`�E'��`~ �� �State Lic. #�f A�C�SI..��, Z�{C{Citv Bus. Lic.
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<br />BUILDING PERMIT APPLICATION
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<br />:ONTRACT PRICE OF WORK �`" "�Ya, 'a°"''
<br />Existing Use of Building ``�� �� HEAT SOURCE:
<br />Proposed Use of Buiiding ����� Gas '�� Electric other
<br />Building type: � Single Family _ Duplex Townhouse _ Multi-Family _ Commercial
<br />Type of project: _ New Addition �, Remodel Repair T.L Siqn Sprinkler DemoliUon Chanqe of Use
<br />DESCRIPTION OF WORK (additionai space provided on the back) :
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<br />MECHANICAL PERMIT APPLICATION
<br />of ProJect: _New _Addn �"' Alteratlon _Repair
<br />Show Number (#) of fixtures
<br />; A/C — air handling units
<br />� Forced air s stems
<br />Gas piping
<br />i Water heater
<br />1 Gas fireplace
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<br />i Gas range
<br />i Clothes dryer
<br />� I Range hood
<br />' � Exhaust fan
<br />I Heat oum�
<br />i Other
<br />SPRINKLER / SU
<br />Number of
<br />ION
<br />PLUMBING PERMIT APPLICATION
<br />of Project: _New _Addn ;_Alteretion _Repair
<br />Show Number (#) of fiutures
<br />I I Toilet
<br />Bathtub
<br />- Lavato wash basin
<br />Shower
<br />� Kitchen sink & dis osal
<br />�' Dishwasher
<br />Ciothes washer
<br />Water heater
<br />Sink service/bar/mo /etc.
<br />Backflow reventer
<br />Urinai
<br />Drinkin Fountain
<br />Floor drain
<br />Grease tra
<br />Roof drains
<br />Medical Gas
<br />Other:
<br />I here6y certify that I have read and eua ' ed this liqtion and know the same to be We and coRect. AII provisions of haws and ordinances goveming this type of work wili be comp
<br />with whether specified herein o not. e granfing of pertnit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construcGon
<br />That I am authorized by the er is properry to erfortn tha worlc for which appGcation is made and I comply with the State Coniraciors Law 1827 RCW and 298.200A WAC.
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<br />Owner/Authoriz d Ag t Signature Date (Revised 9/3014J
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