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l <br />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 />LEGA LOT NO. BLOCK <br />TRACT <br />DESC. S <br />OWNER ADDRESS ZIP PHONE <br />rno, / 'k 7�7� �l/f�f7, IN d. 9&005� 3S'� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />� ��.� ��• ,ifs �S 3�� �szz <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building D Mechanical <br />PERMIT Combination u Plumbing <br />AddiOon <br />WORK Alteration <br />HEAT SOURCE <br />Electric <br />-�J1<Lt AA/��4 <br />.0 / <br />TYPE Demolition U Sign <br />TYPE New <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK---""'—`---"--o-'"-'-'-------__ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3108 <br />WORK DESCRIP �k�IST1i:-ti 5� �Qf/�?GUAC� G iCI�C(J SI/vS?e- F.On71 CY <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A/C - A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY FRAY <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 />BACKFI.OW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <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 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 2J6t200 WAC. <br />r <br />Signatu[e-ot Owner/Contractor/69thonzed Agent Dale <br />L DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />