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r <br />ri <br />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 AD RESS <br />PARCEL TAX I.D.1t <br />PERMIT N <br />LEGAL] LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWN E ADDRESS ZIP PHONE <br />�Iu Pe W-2ol ?r-�oq- <br />TENANTNAME <br />CONTACT FOR PERMIT PHONE <br />I <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE R <br />06Ale�-1'15f4�Ia�"� ll�o�ro DaveSJ0-CZ A)S— <br />PHONE <br />NZ Z Scl tv ) �i�e ✓ UJXI �2v / <br />PROPOSED USE OF BUILDING <br />Building echanical <br />Addition <br />HEAT SOURCE <br />rL�• <br />Sn�IQ .�,YU�) '- ^�% <br />PERMIT <br />TYPE <br />I <br />B Combination Plumbing <br />Q Demolition Sign <br />WORK <br />TYPE <br />B Alteration <br />B New <br />nEIscW <br />Gea <br />f <br />Sprinkler <br />Repair/Maint. <br />OO�er <br />CONTRACT PRICE GF WORK 33 I I , :t <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 <br />WORK DESCRIPTION T `' , (t /ZI, , 'SfAJe ( 4r qla,� <br />♦ EL�J6-i c j, j i-e / 6�ea S '�x�t' ✓ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C — AIHANDLINGUNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />UR{NAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />` <br />GAS PIPING <br />_� <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />JB <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 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 AUTHORIZED BY THE <br />OWNER qF THIS PROP, TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA TORS LAWI 143.17 RCW AND 236.200 WAC. <br />Signoture o wner/Contractor/Authoriz d Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />