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APPLICATIONCITY <br />a*v or weaea sexm. sexnc <br />OF EVERETT PERMIT SERVICES��IZ�320U CEDAR STREET, EVERETT, WA 98201�/425-257-8810 <br />-FAX 425-257-985�LSITE <br />ADDRESS <br />PARCEL TAX LD. >E <br />'39ooU <br />�/MITf"iD��0EH00 <br />(tiib✓ poi <br />bSLEGALBLOCK <br />TRACT�/DESC.l'�fiiAGHI%Ca <br />OWNERADDRESS21PPHOEg'ZS�IIp��EEC.N�3y�,�'-TENANT <br />tl�C e�ti � _ic:1 <br />NAE CONTACT FOR PERMIT PHONE�,�SNr1w�rua3s-�3y�1 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE p <br />bWv��'�owr�2-+4L5.31q-s4z�� <br />PHONEL�t�rs�2iCPROPOSED <br />.tee �r,c... fluilding�P;Fs:"o,.e:°PCRMIT <br />USE OF BUILDING Mechanical ���lllrrr��J✓✓✓AdditionHEATSOURCEPERMITombination�PlumbngWORK�Allerauon�lectric <br />TYPEemolition DSign TYPE Newas <br />prinkler RepairlMaint. Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <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 — AlHANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />� <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />J— <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />_ <br />DISHWASHER <br />_RANGE <br />HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_METAL <br />FIREPLACE/STOVE <br />_ <br />URINAL <br />_FIREPLACE <br />INSERT <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />_ <br />_ <br />B.'.CKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BAR/MOPIETC.) <br />Z <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 />I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIT" TD VIOLATE OR CANCEL THE PROVISION OF ANY OTHER i <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 />CONTR,AC�RS L,AW27 RCN AND 290.200 WAC. <br />�i� <br />Sign lure o caner/ ontractorlAuthonzed Agent Date (� <br />L <br />DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br />14111 14 <br />PERMIT APPLICATION <br />