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P&MIT APPLICATI(% ® EcL <br /> CITY OF EVERETT PERMIT SERVICE l MAR <br /> ® D <br /> 3200 CEDAR STREET, EVERETT, WA 98201 212 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> 10901 2 -N A�_ 1203 -00 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> � �5 wlorJf�y U;Glmef-►TAP4 51jE s <br /> TENANT NAME <br /> ms` CONTACT FOR <br /> FOR PERMIT PHONE <br /> v /� �I <br /> CONTRACTOR �J /�/1� ADDRESS II-7't:y _1 C� ZIP CONTR. LICENSE# <br /> PHONE ��,M I��� ��V� IlnJ�t ��� I�S���J��Q ✓ <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT Combination Plumbing WORK Alteration Electric <br /> TYPE Demolition Sign TYPE ew Gas <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK / CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> Ll�Ste- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. . TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET (TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> -LAVATORY(WASHBASIN) HEAT PUMP- - - <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER 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 EJZLV AND 295.200 WAC. <br /> Signature Owner/C tr ctor/Au rized Ag Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED �' <br />