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i,, <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. ;. <br />I PERMIT# <br />LEGALI LOT N0. <br />BLOCK <br />TRAIT <br />DESC. <br />OWNER <br />ADDRESS <br />ZIP PHONE <br />&k.�,f,Rrl, <br />a90a- <br />TENANT NAME <br />CONTACT FO <br />PERMIT PHONE <br />Gr itfllS �I�rna� <br />f I <br />kf1t h4(- _ 7'T'-Q7,4 <br />CONTRACTOR (� <br />5' n <br />C ADDRESS <br />Tet1i Elec C lLG <br />ZIP CONTR. LICENSE n <br />g90j) <br />3s�6`l <br />R*`' SLGViSLgi95&G <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building <br />i--1 Idechanical <br />on <br />HEAT SOURCE <br />_ <br />PERMIT <br />B Combination <br />II��-3(F Plumbing <br />WORK R.AN'12tion <br />Eiecnc <br />I <br />TYPE <br />B Demolition <br />Sign <br />TYPE New <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK �OO y, <br />I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION Q4azk 0) mgio� LsItd-e WbuW+ S�11 4.0 F,-tc4P <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHESWASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SACKFLOW PREVENTER <br />SINK(SERVICEBAR/MOP;ETC.) <br />OTHER <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. T,iAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION !S MADE AND I COMPLY WITH THE STAI E <br />CONTRACTORS LAW 18.27 ROW AND 296.200 WAC. <br />� r <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />lia <br />