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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: p <br />C'Y-C tr orof r 1 <br />PROPERTY TAX If <br />PERMIT# <br />LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br />OWNER44 <br />Phone/E-mail <br />Address <br />City/State/Zip ti,--r c <br />CONTRACTOR - E'c' �_ <br />L & I Lic. # <br />Address f„r Phone/Email --Z .2 <br />TENANT SINESS NAM <br />— >, <br />CONTACT FOR PERMIT <br />?tP� qrk <br />Phone/E-mail — Oo 2. <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK -J1' 4;:De =° <br />Existing Use of Building I 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 />':T-nS+-qli Cl,a�re L-eqers d-n G'all <br />Have you started working without a permit? _YES ENO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alta. ation _Repair <br />Show Number (#) of fixtures <br />Type of Project: _Now_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backfiow preventer <br />Unit healer <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby certify that 1 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 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 of 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 work for which application is made and I comply with the Slate Contractors Law 18.27 RAW and 296.200 WAC <br />-12- <br />O erfAut zed Agen ignature Date (Revised Z2011) <br />