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PLRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />i <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />ERMIT <br />w C.�s.cl.1 h.�. / i <br />l Vb <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />OESC.' <br />OWNER ADDRESS ZIP PHONE <br />% <br />47// <br />TENANT NAME. <br />CONTACT FOR PERMIT PHONE <br />ADDRESS ZIP CONTR. LICENSE # <br />�ONTRACTOR <br />h,,rt p,�fZ D,4vssasi��c <br />PHONE <br />PROPOSED USE OF BUILDING Building Mechanical I Addillon I HEAT SOURCE <br />PERMIT Combination Plumbing WORKH ARerP Electnc <br />)alion <br />11 TYPE Demolition Sign TYPE New Gas <br />L�j <br />Sprinkler Repair/Malnt. Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />r <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <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 />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />_ <br />SINK (SERVICE!BAR/MOP/ETC.) <br />EXHAUST FAN <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 N RESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR CAL LAW OULATING CONSYRU TION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />WNER TIS PR :RTY TO PERFO TH WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />OWNER, <br />CONTR TOR 19)T W AND 2 .200 AC, <br />i�� l� <br />Contractor <br />ignature of nen ikon d Agent Date / <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />