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AMIT APPLICATIOA —� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # w� PERMIT # <br />cl io E 6i.rc f� /na I k1� 2 1 /fA/ /%%�� 3- 7 <br />LEGA LOT NO. <br />BLOCK TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />Cr fs l3 - 4: &Aed Ai/rkaeig 14 r 3 <br />TENANT AME <br />/ PHONE� <br />CONTACTr,-fk <br />I <br />�'tr�n 33 06� <br />�11JIA}},`DDDRERES <br />...LLL/(((«[GGG-,,, <br />m1� <br />CONTRACTOR ZIP CONTR. LICENSE # <br />Jcvr�' USA 211v1nsrc,.: ,Pxll�,yhaP, (,(l IVAo 6CLAIWQa5z-.S <br />PHONE <br />()-733-5Z <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building f[hC-Me Bnical <br />Combination B_Plumbing <br />WORK <br />Additlon <br />R Alteration <br />HEAT SOURCE <br />DElectric <br />TYPE <br />Demolition Sign <br />k <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repair/Maim. <br />Other <br />CONTRACTr--PRICE OF WORK /�VIW� M. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />&9 <br />A/C —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 />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 />BACKFLOW PREVENTER <br />T7 <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN <br />_ <br />i <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 />I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />0 E OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />c C ORS LAW 16.27 RCW AND 296.2 C. <br />Signature of Owner/ContractCy horized Agent Date �Z <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />