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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 />PERMIT # <br />U q - 4 \ e °�.� <br />a.. - a % <br />LEGALI LOT NO. BLOCK <br />DESC. <br />TRACT f <br />G� <br />t <br />a9 <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />;LZ— 7L43—1 <br />�l 7 19 <br />CONTRACTOR ADD SS ZIP CONTR. LICENSE # <br />ACQCIL, eY4%.I_p gg6t� LICENSE <br />PHONEA <br />FPS 7 �13y17 <br />PROPOSED USE OF BUILDING <br />uilding <br />Addition <br />HEATSOURCE <br />�PERMIT <br />TYPE <br />FpeChanical <br />ombinationumbing <br />Demolition Sign <br />WORK ` AlterationElectric <br />TYPE ew <br />s <br />Sprinkler <br />Repair/Maint. <br />U Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT 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 ITEM <br />WATER CLOSET (TOILET) <br />A/C —A/HANDLING UNITS <br />SL <br />BATHTUB_ <br />FORCED AIR SYSTEMS <br />q_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_I <br />SHOWER <br />UNIT HEATERS <br />-I— <br />KITCHEN SINK & DISPOSAL <br />t <br />CLOTHES DRYER <br />_j_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />_I <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />�— <br />GAS FIREPLACE, <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />r, o— J'L o.� _ 1 <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. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signa ur f Owner/Contractor/A orized A nt Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />