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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 <br />PARCEL TAX I.D. # <br />PERMIT # _ <br />I S <br />LEGAL LOT NO. <br />BOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE. <br />TENANT NAME <br />CONTACTFORP MIT I PHONE <br />es-%s --� �a <br />&,16w <br />11 <br />ZIP CONTR. LICENSE# <br />CONTRACTOR ��� �/{i3Lo 1,E--/77 <br />(i %e� � <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />fi Building IS <br />umbi icalditio <br />11�—U((( Combinallon umbing <br />WORKPAII'teatl'onr <br />HEAT SOURCE <br />j7 Electric <br />T) PE <br />Demolition gn <br />TYPEw <br />Gas <br />Sprinkler <br />paiNlAaint. <br />I Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />/' <br />WORK 0 SCRIPT ON rd✓i 5 <br />1i15// �v/� Corr�'h5�n� vri Ti ro % i� //-/'P' Z� � <br />/� <br />�OI� 1151/t�/ tlYli'f5 4-o S%i' ev, f�r-o 4A <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM — <br />WATER CLOSET (TOILET) <br />_ _ <br />AIC - A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH FASIN) <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 />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN <br />_ <br />_ <br />OTHER <br />_ <br />OTHE/F3/_ <br />Cy��c(l�'$i7 Lgti fS <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.4UTHORIZEO BY THE <br />OWNER OF THIS PROPER TO PE OR THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTkAC R W 1B. CW A 2 .200 WAG. <br />S'gna R ner/Contractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />