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F ERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES 2 - j `1 <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 - vywW.everettwa.org--\ <br />APPLICATIONS ARE ACCEPTED FROM8 AM TO 4 PM (\ � /a —Oar <br />SITE ADDRESS: <br />P11PERTY TAX <br />PERMITO <br />LEGAL for new construction: Short Plat/subdivision Lot No. ;attach copy of long legal description) <br />OWNER \.i,� <br />Address C <br />Phon. 'E-mail <br />City/S:a:e/Zip <br />CONTRACTOR t <br />qq <br />L& I Lic. # <br />Address I I <br />Phone/Email <br />TENANI" BU INE S NAME <br />0,-TIA OLOGkA t. A t -E 51 IJ <br />CONTACT FOR PERMIT <br />` I <br />Phone/Email <br />BUILDING PER IT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building EA 'tip C A v< HEAT SOURCE: <br />Propo3ed Use of Building JA"Z= _ _ _ Gas_ Electric_ Other__ <br />Building type: Single Family _ Duplex _Townhouse _ Multi-FaMulti-Family Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair VamT.I. _ Sign __Sprinkler _Demolition_Change of Use <br />Description of Work (additional space provided on the back): <br />Have You working without a permit? _YES VNO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />_Now _Addn —Alteration _Repair <br />:how Number (#) of fixtures <br />Typoef Project: __New_Addn _Alteration_Repalr <br />Show Number(it) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced airs stems <br />f Bathtub _ <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shcwer <br />Gas fireplace <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas ran e <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />_ <br />Sink service/bar/mop/etc.) <br />Heat um <br />_ _ <br />Backfiow preventer <br />Unit heater <br />Urinal <br />_ <br />Boiler <br />Drink in Fountain <br />_ <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />_ _ _ <br />Roof drains <br />_ <br />Other <br />_ Medical Gas <br />SPRINKLER <br />/ SUPPRESSION SYSTEM <br />_ Other <br />Number of Heads <br />I hereby certify that I have read and examined this application and know tho same to be true and correct. All provisions of laws and ordinances goveming <br />this type of work "It complle n wheth specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the provislon of ny Ter slate r cal law re ulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform ine r f g> idr icallon Is I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />- 2 - 3 - I l <br />Ownor/A orizotl t Signature Dale (Revised 1212010) <br />S <br />