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PERMIT APPLICATION <br />BUILDINGIMECHANICAL/PLUMBINGISIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everefta.org <br />vrsren cony A AM Tn d DM S--3n--I']. <br />APPU .w I PUNS nncRADDRESS: <br />nd Ave <br />PROPERTY TAX# <br />PERMIT# <br />for new construction. Short Platlsubdiwsion Lot No._(attach copy of long legal descnPrion) <br />RPhonel&mail <br />/ <br />c -+ VA c <br />Cily/Statelbp <br />CONTRACTOR <br />Phone/Email WIG — <br />tlresa <br />U I <br />T{{ENAN��T BNE NAME <br />NTACT F <br />[' <br />1./ �P <br />C <br />�/--yP�E/REMIT <br />Phona/E-mail f/�iVI��I�A IL'�1 <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />HEAT SOURCE: <br />Existing Use of Building <br />Electric ✓Other <br />Gas <br />Proposed Use of Building <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 (eddifonet space provided on the back): <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMB NG PERM2 APPLICATION <br />I Type of Project: _Alteration_Repair <br />Type of project:.PAL Nthe #pair <br />_Naw_Addn <br />ow ShNumber (a) or fixtures <br />how Number(# orfixtunad� <br />I A/C — air handlingunits <br />Toilet <br />I Forced airs stems <br />Bathtub <br />I Gas piping <br />Laval wash basin <br />Water heater <br />Shower <br />Gas fire lace <br />I Kitchen sink 8 dis al <br />Gas ran a <br />Dishwasher <br />Clothes d er <br />Clothes washer <br />I Ran hood <br />Water heater <br />Exhaust tan <br />Sink (service/barlmopletc. <br />I Baddlow, reventer <br />Heat um <br />Unit heater <br />Urinal <br />Boiler <br />I Drinki Fountain <br />Refrigeration <br />Floor drain <br />I Grease tra <br />I Woodstove <br />Ducting <br />Root drains <br />Medical Gas <br />Other: <br />Other <br />SPRINKLER I SUPPRESSION SYSTEM <br />Number of Heads <br />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 govertxrq <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 or any other state or local law regulating construction or the performance of construction That I am authorized by the owner of this property <br />to perform the for which ap tia8 n is made and I comply with the State Contractors Law 18 27 RCW and 296.20o WAC <br />OvmerlA rl:ad Aga Slgnatu D e (Revised 2)2011)/ <br />�/ Z <br />