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a <br />PLRMIT 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 />P RMIT # <br />' <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS _ t ZIP PHONE u-LC, <br />TENANT NAME �_ <br />CONTACT FOR PERMIT PHONE <br />I <br />CONTRACTOR ADDRESS �� &y-tt2 ( ZIP CONTR. LICENSE # <br />Z7.5- NC7. IDI Mt= <br />Y)ly y-k ~-Teb 4 V3 (It-, <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building D Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />R"Combination �j Plumbing <br />WORK <br />Alteration <br />Electric <br />TYPE <br />B Demolition U Sign <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION �, �t'y r"j� /12S -^ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A/C — A/HANDLING UNITS <br />i d <br />BATHTUB <br />z <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />;•_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />2 <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_y= <br />RANGE HOOD <br />IAUNDRYTRAY <br />z <br />WATER HEATER <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 />Z <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 NOT PRESUME'i 0 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 PERFORt_J,THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAWW11 C WAC. <br />/ND_,206.200 <br />/ <br />Signature of Owner/Contractor/Authorized Agent Date �J <br />/ <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED --�7r p(p"V�S <br />