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PERMIT APPLICATION <br />4:7r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />(1)/ 063/4)0C)0/9 06> Z102-69:3 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />7 <br />L ES LOT NO. BLOCK TRACT <br />C$ <br />IZS, L, Vzf yz Zzglc-�ff F62�7ffS t-1, JX;:� <br />OWNER ADDRESS ZIP PHONE <br />Z'l rc� --3 (1(t <br />TENANT NAME I CONTACT NAME PHONE <br />I1?11-10— S V — oZ <br />,CQjNTRACYOR f� ADDRESS t w ZIP CONTR. LICENSE # <br />X � ci/� fTT cl F ,)6 <br />PHONE <br />PROPOSED USE OF BUILDING M B 'Iding Mscharlioal t m Additioh"',' + HEAT SOURCE <br />PERMIT nation Plumbing WORK Alteration VEI.ectric <br />TYPE Demolition Sign TYPE ew Sprinkler Repair/Maint. er <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�9 e13 n <br />WORK DESCRIPTION <br />PLUMBING MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br />3— <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL. <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />/4 <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 />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 />Signature of Owner/Contractor/Authorized Agent Date <br />a 9w5 <br />