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' PERMIT APPLICA's ION <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 />20W <br />PARCEL TA); I.D. N <br />PERMIT a <br />.S{�l <br />LEGAIJ LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />r-Ll L�m5 Q �5eo-s <br />lAhT NAME CONTACT FOR PE IT PHONE <br />- <br />OYTRAC7� ADDRESS ZIP CONTR. LICENSE N <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />Addition <br />HEAT SOURCE <br />I <br />PERMIT <br />IR-( Combination Plumbing <br />WORK Alteration <br />R Electric <br />, <br />/v A- <br />TYPE <br />L_j Demolition Sign <br />TYPE New <br />u Gas <br />L) Sprinkler <br />Repair/Maint. <br />LJ Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERE17 LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION \ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. ' TYPE OF FIXTURE OR REM <br />_ <br />WATER CLOSET <br />A/C - A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/FT(-,.) <br />EXHAUST FAN <br />OTHER <br />OTHER <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 CR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THc STATE <br />CONTRP CTORS LAW 18.27 -AND 296.200 WAG <br />i t <br />_ <br />Signal re rOwner/Contracto,. uthonzed 6&nl -( Date <br />®3 0s ~ a <br />DEBIT & CREDI ARDS ARE NOT ACCEPTED <br />