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SITE ADDRESS <br />S! S .S <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />�µ--QD n--� <br />CONTRACTOR <br />PHONE <br />P�t�MIT APPLICATIC�I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />� <br />BLOCK <br />¢ 7 �.i <br />1���s� �� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERNiIT <br />ADDRESS <br />Building D Mechanical <br />PERMIT � Combination u Plumbing <br />7YPE Demolition U Sign <br />Sprinkler <br />WORK DESCRIPTION � <br />.�j U�-Q �cA-� <br />I,ilUUZ,� dLd�'�-� iv� f--� / <br />PLUMBING <br />NO. I 7'1'PE OP FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />,�C �Q,� C�� � <br />G <br />PHONE <br />- O6� <br />GONTR. LIGENSE 8 <br />�Addition <br />Alteratlon <br />New <br />RepaidMaint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />( o �� - a�c�u� � `� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <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 IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �VITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUP,IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHiCH APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW ANO 296200 WAC. <br />Signature of OwnedContractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />