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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 />SITE ADDRESS: PROPERTY TAX # P MIT #
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<br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br />OWNER ���' v i � ,:r (' 'r ' � r , � � , \ Phone/E-mall % t `1 _. '7� -� _ ; J� ' i : � '!'r �
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<br />Address _ � � / ~ i Jn � �, ��� � • -� City/State/Zip ' � ; a r ;' •�7� ,,;' ..r °� � _, __ ,
<br />APPLICANT: ; Qwner _ Owner's Agent _ Contractor _ Contractor�S A90flt _ Tef18f1� (must provide a letter of consent from ihe owner to do work in the space)
<br />CONTRACTOR � 1 �- ' ��� f� •' State Lic. # City Bus. Lic. #
<br />Address Phone/Email
<br />TENANT BUSINESS NAME CONTACT FOR PERMIT
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<br />Phone/E-mail - , _ �? i ; �� (-�' � . � � � y °� � ✓� � �, , o
<br />BUILD�hiG i��IZMIT APPLI�A'�"ION CONTRACT PRICE OF WORK ��-(U�_�. .'�:-J
<br />Existing Use of Building "`"� -' " ^% HEAT SOURCE:
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<br />Proposed Use of Building � '� r� r t ��' �^ �`'� Gas� Electric_ other_
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<br />Building type: _!Single Fam�ily _ Duple�/x'�� Townhouse _ Multi-Family _ Commercial
<br />Type of project: New °✓" Addition f Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use
<br />DESCRIPTION OF WORK (addition ! s,pace proyided on the back) : ,�., , _ .., � , , ,.3 �,i;, ; r;.,,, ; ,
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<br />MECHAP6ICAL 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 y j Toilet
<br />� i Forced air systems '' I Bathtub
<br />� i Gas piping :� � Lavatory (wash basin)
<br />; Water heater "� ; Shower
<br />+f+-;,a Gas fireplace � 3 � Kitchen sink & disposal
<br />� � Gas range I Dishwasher
<br />� Clothes dryer I i Clothes washer
<br />Range hood Water heater
<br />'= j Exhaust fan � Sink (service/bar/mop/etc.)
<br />i Heat pump Backflow preventer
<br />i 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 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 this type of work will be complied
<br />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction
<br />That I am authorized by the owner of this property to periorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
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<br />Owner/Authorized Agent Signature Date (Revised 3/2013)
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