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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Sl., Everett, WA 98201 -425.257-8810-FAX 425-257-8857-www.everettwa.org _ / Z <br /> APPLICATIONS ARE ACCEPTED FROM a AM TO 4 PM 3 <br /> SITE ADDRESS: PROPERTY TAX p PERMIT p <br /> n C it F v"e I W I o3 _�. <br /> LEGAL for new construction. Short Plallsubdivision Lot No_ (attach copy of long legal description) <br /> OWNER ( ;41 i Phone/E•mall '31`5 <br /> Address 1 w t- [a.-el i' VA CIIyBtateZp E..,!e 1' � <br /> CONTRACTOR n In+r a (�� '1- µ,.l:•. L 8 1 Lic.p AL u�`>110 <br /> r. QPhone/Email "Oss,05 0,.2y J'.se�v p.G.v. <br /> Address �[l ,�cx WSS- M„ �Shcl� W 4J � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E.mall <br /> BUILDING PERMIT APPLICATION ICONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Elacinc Other <br /> / <br /> Building type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(eddifroref space provided on the back): <br /> Have you started working without a permit? _YES '4 NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Now_Addn _ Alteration/Repair Typeof Protect: _New—Addn <br /> _Alteration <br /> Alter tion_Repalr <br /> Show Number a of fixtures <br /> AIC–air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gan piling Lavatory wash basin <br /> Water healer Shower <br /> Gas fire lace Kitchen sink 8 disposal <br /> Gas ran a Dishwasher <br /> Clothes d er Clothes washer <br /> Ramos hood Water heater <br /> Exhaust fan Sink servicelbarlmo lett. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkln Fountain <br /> Refrigeration Floor drain <br /> Woodstova Grease tre <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER'/ SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> I hereby certify that I have read and examined this application and know the some to be true and correct All provisions of laws and ordinances governing <br /> this type or 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 /> ere provision of any other state or local law regulating construction or the perform arca of construction That I em authorized by the owner of this property <br /> to perform the work for which application is made and I comply with the State Contractors Law to 27 RCA,and lee.200 WAC <br /> (Revised 7/2011) <br /> Owner/Authorized Agent Signature Dale <br />