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f <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT u <br />%3�/ni N��a. avC �✓.ve.�9� <br />d pvbf zD�Ot7Ug84d <br />��.C�� <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE p�.2.r''2j7f-G <br />iiJ�c Y71 � n �' / VCR/ Ue �j d L✓ //7A �t L��R. 0. VG ✓ GY-� li.�� � 07 d <br />TENANtNAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE h <br />PROPOSED USE OF BUILDING QQQQR BUlldIIng Mechanical Addition HEAT SOURCE <br />PERMIT Combination Plumbing Alteration )7(Electric <br />.IfKi1(r (WORK <br />�t SLCl rX f, TYPE f6) Demolition LJ S"ign TYPE New B Gas <br />Other <br />L/ <br />r(- Sprinkler Repair/Mainz. <br />CONTRACT PRICE OF WORK �a 7r �'a� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i <br />WORK DESCRIPTION <br />c� <br />e i i✓/rd <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A/C-A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />oZ <br />UNIT HEATERS <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 />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER n <br />OTHER <br />— <br />'JJ <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 />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 18.27 RCW AND 296.200 WAC. <br />�! 3-3o-may <br />'ler <br />Sig ature of Owner/Contractor/Authorized Agent Date <br />(/� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />