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PERMIT <br />425-257-8810 -FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. # PERMIT z <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DSC.E <br />— <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE p <br />/%r Wu)i a`bur/I 9100) <br />erne%aG�>'anP 5,0!� D.b <br />PHONE <br />PROPOSED USE OF BUILDING <br />li Building li Mechanical <br />IIL�J( <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination Plumbing <br />WORK <br />Alteration <br />QR Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repair/Maim. <br />V <br />U Other <br />CONTRACT PRICE OF WORK <br />i <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE ',F FIXTURE OR ITEM <br />A,IC — A/HANDLING UNITS <br />WATER CLOSET (TOILET) <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 8 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 />BACKFLCW PREVENTER <br />_GAS <br />PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS,4ND 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 AUTHORI iY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I Alvl 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 LAW 16.27 RCW AND 296.200 WAC. <br />C Z3 <br />Signer f Owner, onlraclor/Authorized Agent ate I/ 2- <br />DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br />APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />Ali <br />