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_Y <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810- FAX 425-257-8857 I <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT� <br /> S M o3al-o.3z � <br /> LEGA LOT NO. BLOCK TRACT <br /> oEs�. � `� ZS� s,�� 3zo�! <br /> OWNER ADDRESS � <br /> ZIP PHONE <br /> ,c� � ��1A� � J . rc.�Ac �/� ���aS �o�c/<%.�ic�.d/ �J� � <br /> TENANT NAME I CONTACT NAME PHONE � <br /> 5 .� �S 9..��� �-[�� 7�7� �_ i <br /> CONTRACTOR ADDRESS ZIP COMR.LICENSE N I <br /> PHONE S A� <br /> N <br /> PROPOSED USE OF BUILDING 8uilding Mechenical Addition HEAT SOURCE <br /> PERMIT R Ccmbination R plumbing WORK R Alteretion � Electric <br /> TYPE D Demolition d Sign TYPE D New Ges <br /> ��� � U Sprinkle�(p of heads) U RepelrlMainl Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ;��✓� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlJ(TURE OR REM NO. TYPE OF FlXTURE OR REM <br /> _ WATER CLOSET(TOILET) __ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ FIEAT 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 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 WHEfHER SPECIFIED HEFiEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEF <br /> STATE OR LOCAL LAW REr,ULA7ING CONSTRUCTION OR 7HE PERFORMAWCE OF CONSTRUCTION. THAT I AM AU7HORIZED 8Y THE <br /> OWNER OF THIS PROPEF i Y TO PERFORM T WOR WHICH APPLIC4TION IS MADE ANU I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7 RCW AND 296 0 AC. � <br /> � <br /> Signature of Owner/Contractor/Authorize Agent Date <br />