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P8RMIT APPLICATION <br />S <br />41-rTCITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />SITE ADDRESS <br />CEL TAX I.D. # <br />PERMIT # <br />Goc)Op30LEALG <br />EADDRESS <br />LOT NO. <br />BLOCK <br />DESC. <br />OWNER a✓ r <br />ff�i4gUsj <br />(PHONE <br />Nil <br />30& a <br />TENANT NAME I <br />CONTACT NAME <br />I PHONE <br />CONTRACTOR <br />ADDRESS <br />CONTR. LICENSE # <br />owr-w <br />I <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building n Mach <br />Combination rDj Plumbaing <br />WORK <br />j Addition <br />j� Alteration <br />HEAT SOURCE <br />DElectric <br />AA a5� <br />TYPE <br />Demolition Sign <br />N <br />TYPE <br />New <br />Repair/Maint. <br />UU Gas <br />Other <br />Sprinkler <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION n / v re %; <br />(( <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />_ <br />A/C — AIHANDLINGUNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />_ <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />_ <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN <br />_ <br />OTHER <br />_ <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 />OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS <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 LAW 16.27 RCW AND 296.200 WAC. <br />Signature of Owner/Ccntractor/Authonzed Agent Date <br />