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PERMIT APPLICATION <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 ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />I <br />21 ST= FLr=r2r r 1+I1-1i L <br />(�J rl%I �� UI <br />LEGAL LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE � � �� <br />w... a <br />�L.., .,. ¢.m n:. c.�typr�z <br />1��ic�r(rS I)<u1��L pu fjux' ru�-t7 1,u�a�.t�- q�7L.,�,��o�►- 4zz-�6� <br />TENANT NAME C�ONIT�ACT NAME PHONE <br />C I -('t-t (� l-?�r�YJ2►"` Sep vrCs {�1I111j z_c - �+'Z-7-��'J -- <br />_ <br />CONTRACTOR ��'(-��(I/ G,�L� y ADDRESS ZIP CONTR. LICENSE R <br />1 <br />PHONE <br />PROPOSED USE OF BUILDING <br />n Building Mechanical <br />R <br />Addition <br />HEAT SOURCE <br />Electric <br />PERMIT <br />Combination Plumbing <br />H Nteration <br />TYPE <br />Demolition D Sign <br />(WORK <br />TYPE <br />New <br />Gas <br />� <br />Sprinkler <br />RepairlMaint. <br />Other <br />CONTRACT PRICE OF WORK ���� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WQRK DESCRIPTION <br />WORK <br />�- <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER Cl OSET <br />NC - AIHANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <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 />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BAr,KFLOW PREVENTER <br />GAS PIPING <br />_ <br />SII4K (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORREC T. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NO'. 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 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROjI i PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW AND 296200 WAC. <br />Signature o Owner o t act r/Authorised Agent ale <br />