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PE-�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />-�-3200 CEDAR STREET, EVERETT, WA 98201 <br />�4�5��`�'t � 425-257-8810 - FAX 425-257-8857 <br />`�`�j i �� 3 � i'L � 1'')�'� r'� �' �4� .., �'� l �� 1 V � �'c � G'1''� �j- �' �'� � <br />SITF. ADDRESS' _...--'�� PARCEL TAX I.D. # PERMIT � �� i�; <br />--�' ,/ <br />� �, " " - -i��;�_ ' � ' 0 <br />-.,.�.:__1.. <br />LEC� / LOT NO. BLOCK TRACT <br />DESC. <br />OWNER , , , <br />._ ,_ . _.�1 ; �- _.� .��! ..__ .� - - i._i <br />TENANT NAME �,; , <br />_ � ur rn�rvc <br />: � �� .�'� . ._ !�' /, � - ; -. . , � ' . c,� ' _� /' " � <br />CONTACT NAME <br />� ;�� `"._'i -. <br />PHONE <br />�-,/ _. - _..���)�-/�'� <br />CONTRACTOR ,!. ; , . ADDRESS � ,-�,' ,_, , . ; r , , .�-.i ` ?. ZIP CONTR. LICENSE # <br />.,_ . _ ;.,._ � <br />i'_ '. i.; G Ll �,_ ,._ �'/ i- <br />PHONE -�i . - <br />� � ��,' � <br />PROPOSED USE OF BUILDING Building j�p Mechanical Addition HEAT SOURCE <br />PERMIT Combination �_� Plumbing WORK Alteration Electric <br />TYPE Demolition LJ Sign T`�PE New � Gas <br />Sprinkler � RepairiMaint. Other <br />CONTRACT PRICE OF WORK �<"`; . � - <br />WORK DESCRIPTION � ,_, �." t,l �i' ,_ /r1. , ' <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATEFi 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 />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� -, /1�, „ , <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />,�, <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <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 COFRECT. 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 PROPEFTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOI�S LAW 18.27 RCW AND 296.200 WAC. <br />� <br />� , <br />Signature of Ownet/Contractor/Authorized Agent Date <br />