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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES % <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />,cam <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT m <br />QIV� <br />Ob1�000h� 6 <br />LEGA L TNO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />fG/rAr3�ifF ��Sib� <br />GLJZ0jgrrg i4RiDr - `fps=�9o-�f�S- <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />9r26e <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building f) Mechanical <br />R Combination IVHl Plumbing <br />WORK <br />Ad"on <br />Alt <br />N eration <br />I HEAT SOURCE <br />D ElecUicTYPE <br />Demolition Sign <br />TYPE <br />New <br />B Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31n.5 <br />WORK DESCRIPTION O ,L� STj/} �6r3iL� Al <br />/nlSrA��. a,fX-&2- <br />P4g-C, <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 />_ <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 />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 />STATE OR LOCAL LAW REGUL,.TING 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 />Signature of Owner/Contractor/Author zed Agent Date / 1 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />