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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLMON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />rn ne Cn[onueAYTOAPM A — 9 3 <br />APPLICAIGN. n��,......-, <br />SITE ADD RESS: , <br />,...-........ _......- - <br />PROPERTYTAX # <br />PERMIT # <br />W! <br />LEGAL for new construction: Short Plattsubdivision Lot No._ (attach copy of long legal descnplion) <br />OWNER Lj PhonetE-mail <br />Address S -(. City/State/Zip <br />Li j L& I Lic. # <br />CONTRACTOR t rn <br />Phone/Email CD ' 1 <br />Address / <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />Phone/E-mail O <br />BUILDING PERMIT APPLICATION ICONTRACT <br />PRICE OF WORK <br />HEAT SOURCE: <br />Existing Use of Building <br />Proposed Use of Building Gas Electric_ Other_ <br />Building type: Single Family _ Duplex _Townhouse ,_, Multi -Family _ Commercial <br />_ <br />Type of project: _ New _Addition _ Remodel Repair_ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />Description of Work (additional ace provided on 1heAack)) r h d k4 iUw w� <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Alteratlon_Repair <br />Typeol Project: _New_Addn _Alteration_Repair <br />_Now_Addn <br />Show Number (0) of fixtures <br />Show Number(#) of fixtures <br />I A/C — airhandlin units <br />I Toilet <br />I Forced airs stems <br />Bathtub <br />Lavalo (wash basin <br />I Gas piping <br />I <br />Shower <br />Water heater <br />Kitchen sink & dis osal <br />I <br />Gas fire lace <br />Dishwasher <br />Gas ran a <br />Clothes washer <br />Clothesdryer <br />Water heater <br />Ran a hood <br />I Sink sewice/bartmo letc.) <br />Exhaust fan <br />BaekRoW reventer <br />Heat um <br />Urinal <br />Unit heater <br />Drinkin Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease lra <br />Woodslove <br />Roof drains <br />I <br />Ducting <br />Other <br />Medical Gas <br />SPRINKLER { SUPPRESSION SYSTEM <br />I Other: <br />Number of Heads <br />Other: <br />Bus tic. <br />(0& <br />7lied <br />312411, <br />I hereby certify that I have read and examined this application and know the same to be /rue and correct. All provisions 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 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 for which application Is made and 1 comply win the Slate Contractors Law 18.27 RCW and 298.200 WAC <br />-ZZ- la <br />Owner/Authorizg Agent Signature Data (Revised 2/2011) <br />I �� <br />