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PERMIT AP`PLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/S.PRINKLER/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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDR SS' S 3 PROPERTY TAX# PERMIT# <br /> ^ a o� � e C s�N'� � `� s"9 a - D 1_D <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER jJ��(v�e Phone/E-mai� <br /> Address City/State/Zip <br /> CONTRACTOR O�r (y L&I Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �1�� Phone/E-mail L� �L�/'����ST�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE oF woRK ` OG'� ' <br /> Existing Use of Building ,Ml � HEAT SOURCE: <br /> Proposed Use of Building ��� Gas_ Electric Other <br /> Building type: _Single Family _Dupiex_Townhouse _Multi-Family �Commercial <br /> Type of project: _New _Addition Remodel _Repair�T.L_Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additional space provided on the back): <br /> (�-rj t� `Z,. s 1�c�,d r�s a iz �'��t�'�i �-��� : <br /> Have you started working without a permit? YES �NO <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 fixtures 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 Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Ciothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.): <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain . <br /> Refrigeration Floor drain <br /> Woodstove � Grease trap <br /> 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 to be true and correct.All provisions of laws and ordinances governing <br /> this type ofwork will be complied with whether specified herein or not.The granting of a permit does notpresume to give authority to violate or cancel , <br /> the provision of any other state or local law regulating construction or the pertormance of construction.That I am authorized by the owner of this property <br /> to pe orm the work for whic ppi' ation is m e and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC �l� <br /> � �(� �� , <br /> OwneNAuthorized Agent Signature Date (Revised 2/2011) <br />