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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 PARCEL TAX I.D.N PERMiT a <br /> o A c S�No 2A. rno��H-�� <br /> LEGA LOT NO. BLOCK TFtACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Yw�'cs �x� �')Act�oN�►d. <br /> TENANTNAME ' CONTACTFORPERMIT PHONE <br /> CONTRACTOR A�� STIOR (�ql ADDRESS�O� �(�( �p • ZIP CONTR.UCENSE N <br /> "� Acc rrNAov�SK <br /> PHONE <br /> PROPOSED USE OF BUILDING Building Mechanical Addlllon HEAT AOURCE <br /> PERMIT R Combinatlon R Plumbing WORK R Alteratlon D Flectrlc <br /> TMPE B Spr nkleion D Sign TMPE B Repalr/Malnl. B o�'e� <br /> CONTRACT PRICF OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS�106 <br /> WORK OESCRIPTION <br /> 1.�J3�r�� n1cW � QIb b 6r��1 <br /> Re�lA�a <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(WASH BASIN) _ HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK 8 UISPOSAL 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 /> I _ SIVK(SERVICE/BAR/MOP�ETC.) _ EXHAUST FAN <br /> I _ OTHER _ OTHER <br /> ' i HEREBY CERITIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> NOT. THE GRAN7iNG OF A PERMIT DUES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL U+W REG IN STRUCTION OR THE PEfiFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BV THE <br /> � OWNER OF THIS PROPER 10 P FO M THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1 .7 RC AND 2 .200 WAC. <br /> I <br /> I Signature of Owner/Conlract lAvthonzed Agent Dale <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />