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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES /Q — " —/3 <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 P I 3 f D- D d$ <br />TE <br />D ASS' F'I4 <br />PROPERTY TAX # <br />PE T# <br />LEGAL for new construction ShoShortPlatlsubdwlsion Lot No _ (attach copy of long legal description) <br />OWNER <br />Phone/E-mail <br />Address , / c litif62 <br />Cily1State/Zfp _e, W Z <br />fz <br />APPLICANT: Owner Owner's Agent Contractor _ Contractors Agent Tenant pn,m provide.nd, of consonl from ate o.nerto do ved in bad loaded <br />ONTRACTOR f <br />L 8 I Lic. # COE Bus. LIc. # <br />Across s Phone/Emai - <br />TENANT BUSINESS NAME' <br />tr. <br />CONTACT FOR PERMIT <br />PhonelE-mad r 4-�- <br />BUI DING PERMIY APPLICATION <br />CONTRACT PRICEOF WORK <br />Existing Use of Building H T SOURCE: <br />Proposed Use of Building cos Electric_ Other_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family Commercial <br />Type of project: New Addition RemodelRepair l/T,1. _ Sign —Sprinkler _Demolition_Change ofUse <br />DE^CSIrP�TIO`NfOFW al�a00rov� e t�Da�ck1 , ll/is&J 1120(kdeAii, pith �ill`"y.� <br />N J t r µ/ C ✓ <br />C <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Arfdn Alaratiog _Repair <br />Show Number (#1 of fixtures <br />Type of Project: New _Addn _Alteration _Repair <br />Show Show Number (0) of fixtures <br />A/C - air hanclAgunits <br />I Toilet <br />Forced air Wslems <br />Bathtub <br />Gas pipiA <br />Lavatory (wash basin) <br />Water eater <br />Shower <br />Gas replace <br />Kitchen sink 6 disposal <br />GA- range <br />Dishwasher <br />%lothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (servicelbarlmo /etc.) <br />eat pump <br />Backllow preventer <br />Dilit healer <br />Urinal <br />Drinktn Fountain <br />DON <br />Refti ration <br />Floor drain <br />Woods) a <br />Grease trap <br />Ducting <br />Roof drams <br />O e <br />Medical Gas <br />PRIN�§411IIPPRESSMN SYSTEM <br />Other: <br />u of Heads <br />Other: <br />harcb ccfldy that I have read and erammed N¢ a�Wn and knew We vine to be Into and wood. All proviwons of Wrs and ordinances gove volt dus type of work will be complad <br />with whether spetihed herein or not. 1 he granting of a permit does nor presume to gum aulhomy to vwlam or umct.l the provision of any other state or local Law nigulalmg cnnstruNon <br />Thal 1 am mflhorinel by the owner of this property to perform the wok for which application Is made and 1 comply with the Slate Contractors L.mv 18 27 RCW and 206 200A WAC. <br />Ow a II uthorized AgentSignature { t a ~I� (Revised 62012) <br />