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• • <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 />-:t tS r 1—/V —/ `/ <br />ADDRESS: _ I IPROPERTY TAX <br />for new construction: Shod Plat/subdivision Lot No _ (attach copy of long legal description) <br />Address I,— Cily/Slate/Zip <br />APPLICANT: Owner _Owner's Agent _Contractor _ Contractor's Agent _ Tenant )men provleaaece: mcamem oom In. o..rer:o do won, In no space) <br />Lic # <br />Phone/Email <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK _ <br />Existing Use of Building 21C HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric_ Other_ <br />Building type AeSingle Family Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project: _ New —Addition _ Remodel V Repair _ T.I. _ Sign _Sprinkler _Demolition_ Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) <br />I MECHANICAL PERMIT APPLICATION I I PLUMBING PERMIT APPLICATION I <br />Type of Project: _New _Addn _Alteration _Repair I (Type of Project: _New _Addn Alteration _Repair <br />Show Number(#) of fixtures Show Number(#) of fixtures <br />heater <br />Shower <br />i7 <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads Other: <br />I hereby codify 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 wtl 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 stale or local law regulating construction <br />That I am authorized by the owner of this property to pedorm the work for which application is made and I comply with the Slate Contractors Law 16.27 RCW and 296.200A WAC <br />Q <br />OwnerlAuth ri ed A I <br />t Signal I <br />re Date <br />(Revised 312013) <br />