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i <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 />APPI ICATIrue ADC ♦r .ten �...... ... _ <br />------•- - �..�.. rnWw. oMIw IV • rm J `ar?(�r. <br />PROPERTY TAX M <br />�l[ WA PeR[+ITs . <br />uction: Short Plat/subdivislon tree-1 V'Lot <br />No._ (attactl copy of lap legal description) <br />fffor <br />'— <br />mail <br />City/Slatelzip <br />CONTRACTOR��—"Zc ) <br />L & I Lic. 8 JIB <br />Address 1u rr— �..--, 4, G ,["' PtrorlelEmall <br />_ <br />TENANT tiU INE NAM CONTACT FOR PERMIT <br />. Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />HEAT SOURCE: <br />Proposed Use of Building <br />BuildingGab Electnc Other <br />type: _ Single Family _ Duplex _Townhouse _ Multi -Family Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.I. Sign _Sprinkler _DerTlolition Change of Use <br />Description of Work (additional space provided on the back): <br />Have you started working without a permit? _YES �NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Prefect: _New _Addn _Alteration _Italxalr <br />Ty_Nav_Addn _Albratlon_Repair <br />Show Number (Ay of fixtures <br />Show Number of fixtures <br />1 A/C — air handlin units <br />Toilet <br />I Forced airs stems <br />Bathtub <br />Gas in <br />I Water heater <br />Lavato wash basin <br />I Gas fireplace <br />I Shower <br />I Gas ran e <br />Kitchen sink R distaosal <br />Clothes d er <br />I Dishwasher <br />Ran a hood <br />Clothes washer <br />Exhaust fan <br />Water heater <br />I Heat <br />Sink servioe/bar/mo etc. <br />um <br />I Unit heater <br />BackBow preventer <br />I Boiler <br />Urinal <br />Refri eretion <br />Drinkin Fountain <br />I Woodstove <br />Floor drain <br />I Ductin <br />Grease trap <br />I Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other. <br />Number of Heads <br />Otter. <br />I hereby certify, that I have mad and examined this application and know the same to be true and correct. AN pmvWms 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, Thal I am authorized by the owner Cf this property <br />to perform the work for which application is made and I Comply with the ';fate Contractors Law 18.27 RCW and 2118.200 WAC <br />vwnarHathorized ARaM Slgoature Date (Revised 2/2011 <br />