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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVI�ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 �, i <br /> C_ �fo3- c�- � <br /> SITE ADDRESS PARCEL TAX I.D.# �P,�RMIT� <br /> % O�- / <br /> .''_ � rl 1 � , �l'L• L������ZC1� (,�.'. `lr�.V (l� �'�.`-a� � � ''i` -'' _' <br /> i <br /> IEGAL LOT NO. 9LOCK TRACT '' <br /> r <br /> oEs�. „ r , ,�;; 'i,7 r n r = �,���zc r7 i <br /> OWNER ADDRE55 ZIP PHONE �,, <br /> � i f "�. : ? ' �VC�t2C� 1,�./.�� '1. l� � � <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> - „ L_ 1�✓s %,.i,, _ . _` C• �r' . - , � <br /> AD�RESS ZIP CONTR.LICENSE# <br /> CONTRACTOR � �. , . , ..•�' . , . 'i ?$rhCR�- <br /> , _, i!'�C S i�'�( tcoLi ;�:,- � • i� . . . . 'Its�. <br /> PHONE _, , . . � '.. � ., , . . ._ ..._ <br /> ,,.1 i 'f ,v `i !'. `' <br /> PROPOSED USE OF BUILDING < Building I� Mechanical I Addition HEAT SOURCE <br /> PERMIT Combination k��(( PlUmbing WORK Alteration Q Electnc <br /> IYPE � Demolition IJ Sign ITYPE New �.j Gas <br /> � .i � Sprinkler I Repair/Maint U Ot`�er <br /> CONTRACT PRICE�OF WORI( �%i J ' ".: � - . CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> .:� .. <br /> WORK DESCRIPTION <br /> �,L'- ��2./�7._�t ^:��/( C,` ;L�.. <br /> PLUMBING '� MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) ., _ A/C—A/HANDLING UNITS <br /> BATHTUB �' � ' FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) � f �i � ` _ HEAT PUMP <br /> SHOWER I _ UNITHEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> -- AL FIREPLACE/STOVE <br /> _.I CLOTHES WASHER _ MET <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREI�LACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> I SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAM11E TO BE TRUE AND CORRECT. ALL <br /> i PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH N'HETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN 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 P�RFORM THE WORK FOR WNICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> I CONTRACTORS L4�,N 18.2Z RCW AND 29"0200 WAC. <br /> . .._. . _,� �;.. ;.' __ ' � `/ <br /> ' Signature of OwnedContractor/Authorized Agent Date pj <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> I <br />