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( ERMIT APPLICAI . JN <br />O:rr CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS '�Kj <{e I PARCEL TAX I.D. k <br />PERM T x <br />'S05 5E EVERFr7 fIR1L W19Y <br />OZ//-004E.1 <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DES C. <br />OWNER ADDRESS ZIP PHONE <br />NAT7 3,C � `E E EPLETr .ZCLa 669-9763 <br />TENANT NAME <br />CONTACT NAME PHONE <br />AN ib.121= 120b)C69.y763 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />719HOKt,c1e COt/sTPtLC7/0/`/ <br />TAHNKC14991 K8 <br />PHON U <br />(�l 3 2-7 9 I () 669-9763cr=1t <br />PROPOSED USE OF BUILDING <br />Building n Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT Combination ILHJt Plumbing <br />TYPE Demolition Sign <br />WORK <br />TYPE <br />R Alteration <br />B New <br />n Electric <br />B Gas <br />Sprinkler <br />Repair/Mamt. <br />Other <br />CONTRACT PRICE OF WORK (!Cl �? £� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />7-1 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 — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <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 />BACKFLOV! DREVENTER <br />GAS PIPING <br />_ <br />SINK (SEPVICE/BAR/MOP/ETC.) <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 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 OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAZY 18.27 RL'W ND 296.200 WAC. <br />Signature of OwnerlCo ractor/Authorized Agent Date �\ <br />