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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 />rncorcn cola Wl a AM Tn A PM � — —.,o —)'-- <br />APPLiCA NI ,\J nn,.. r.---- <br />--- I .._... _ .._. . _ - <br />SITE ADDRESS: <br />PROPERTY TAX # <br />PERI�II,NQ )_ <br />1 IJI(iJf <br />LEGAL for new construction: Shod Plat/subdivision Lot No._ (attach copy of long legal description) <br />OWNER <br />Phone/E-mail <br />Address <br />City/Slate/Zip <br />L & 1 Lic. # }� X' co <br />CONTRACTOR <br />Address / 13I L• S�: ,) c Phone/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />Fran (� <br />J -` P 0I^1 <br />Phone/E-mail s <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />HEAT SOURCE: <br />Existing Use of Building _ <br />Gas_ Electric_ Other <br />Proposed Use <br />1y�yoff'Building ` / <br />g Building type: Single Family _ Duplex —Townhouse _Multi -Family X Commercial <br />Type of project: J_ New —Addition _ Remodel _ Repair _ T.I. _Sign _Sprinkler —Demolition—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 Project: _New _Addn _Alteration _Repalr <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (0) of fixtures <br />Show Number(*) of fixtures <br />A/C— air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />1 I Gas piping <br />Lavato wash basin) <br />Water heater <br />I Shower <br />! Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />I Gas fireplace <br />Gas range <br />Clolhesdryer <br />Ran a hood <br />Water healer <br />Exhaust fan <br />Sink (service/bar/mop/etc) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />I Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodslove <br />Grease trap <br />Ductin <br />Roofdical drains <br />Other <br />MeGas <br />SPRINKLER I SUPPRESSION SYSTEM <br />I Other: <br />Number of Heads <br />I 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 goveming <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 stale or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform the work loll ich application is made and I comply with the State Contractors Law 16.27 RCW and 296.200 WAC <br />�� � •? a• 20�2 <br />Owner/Authorized Agent Signature Date (Revised 2/2011) <br />//a <br />