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:�ERNiIT APPLICATI� <br /> �UILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEIVIOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX S1 PERMIT# <br /> "' � -�:� �'� <br /> LEGAL for new construction: Short PlaUsubdivision ��: z Lot No. ' (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT: Owner _Owner's Agent _Contractor _Contractor�5 AgBf7t _Teflafll(must provida a leqer of conseN from the owner to dp work in the space) <br /> CONTRACTOR State Lic. # City Bus. Lic.# <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUI�DLNG PERMIT APPLICATION CONTRACT PRICE OF WORK "'�'Zl�`1 �, -%' <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other_ <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(additional space provided on the back): <br /> � �i'���;r i1 i,'� � _ . ! - � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fiztures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> , Water heater ! Shower <br /> Gas fireplace i Kitchen sink&disposal <br /> � Gas range _____ —( Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> I Refrigeration Floor drain <br /> j Woodstove � Grease trap <br /> I Ducting � Roof drains <br /> � Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> � Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same io be irue and correct.All provisions of laws and ordinances governing this lype of work will be complied <br /> wilh whefher specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating consiruction <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ��, ���� (����,, � �-� � is- <br /> ,,�,�n� U:��.� <br /> O, ner/Authorized Agent Signature Date (Revised 4/2015) <br /> ! � <br /> \ � <br />