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PtRMIT APPLICATIJ' N <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. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />TEgANT NAME <br />CONTACT NAME PHONE <br />L<r/9 <br />C-Ir- <br />CONTRACTOR /� /1 rr� LC&(�j ' ADDRESS y /,4.V ZIP CONTR. LICENSE # <br />Y p-a-�"r�—ix—`-t � U IJ/ <br />AAAc v rH01 � <br />(� <br />PHONE ✓ � I I �..� (i- v'qe) I <br />PROPOSED USE OF BUILDING <br />li Building Mechanical <br />1� Addition HEAT SOURCE <br />PERMIT <br />Combination Plumbing <br />WORK <br />III-u.-.j(( Alteration j� Electric <br />TYPE <br />Demolili'm Sign <br />TYPE <br />New B Gas <br />IIIIt( <br />Sprinkler <br />Repair/6laint. Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />/ZC• J��d-'rurr='i�IC`i� SyS,Un( /!J'J'�jLjbl� l/v �.-X1,5/ /I�/�'' /'�Gr-:� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />_ <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />_ <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />__ <br />GAS RANGE <br />_ <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUSTFAN <br />OTHER <br />OTHER <br />I HEREBY CERTIFY THAT I HAVE RFAD ANC - AMINED 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 />NOr. THE GRANTING OF A PERMIT DOES NOT PRESU6IE 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 Pf RFORM TH WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTACTORS LAW 1P.22 RCW !D 296.200 AC. p i' <br />� /Ag <br />/ <br />Signature of Owner/ContractovAulhonzed Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />