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Pi�RMIT APPLICATIt�N � z --� u -0 5 <br /> CITY OF EVERETT PERMIT SERVICES CbSo `�-�� 3 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMiT tt <br /> � -3� /�'��l<;L7c_ c 1�� �0 C�C�Sc, %c, ,� � i o z � oS�7 -�c 3 <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. /3 GC�c' D. �; �' <br /> OWNER ADDRESS 21P PHONE <br /> f`,J�C� /.L � /L� r�/ '/�i!_/ C`',CC��/��l c_/�.' �L `/,C�.:'c�� �/ � .`.> �G'L'- E"'l7 Y t� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE <br /> PROPOSED USE OF BUILDING Building Mechanical r�ta/-Addition HEAT SOURCE <br /> PERMIT R Combination � Plumbing WORK I ) Alteration �lectric <br /> TYPE Dc:rrulition U Sign TYPE New as <br /> B Sprinkle� RepaidMainL Otner <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> W ORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITE�N <br /> WATER CLOSET(TOILET) _ AIC—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I <br /> � I HEREBY CERITIFV THAT I HAVE READ AND EXAA9INED THIS APPUCATION AND KNJW THE SAME TO BE TRUE AND CORREC . <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOZK WILL BE COMPLIED WITH INHETHER SPECIFIEU HEREIN OR <br /> iNOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOtJ OF ANY OTHER <br /> i STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. TI1AT I A�I AUTHORIZED DY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COAIPLY WITH THE STATc <br /> CONTRACTORS L,AW�8.27 RCW AND 296.200 WAC. — <br /> � L----- -, , <br /> �'�� �/�' C`� <br /> �.. .�c �� � " ` �— <br /> i Stgnaturo of OwnedContractor/Authonzed Agent Date 3/� <br /> I DEBIT $ CREDIT CARDS ARE NOT ACCEPTED <br />