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� <br />APPLICATION <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />*`PExmsrsexvices <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />,... ,... <br />425-257-8810 -FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT# <br />4-6- /5- oYT <br />D694o78o/00Z-7 6 40 <br />IYIOff ol-o2rJ <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />X <br />TENANiNAME <br />CONTACT FOR PERMIT PHONE <br />// // <br />CONTRACTOR ADDRESS 21P CONTR. LICENSE # <br />10��1,Ty y` T <br />PHONE <br />Z1Zs 7'13 <br />PROPOSED USE OF BUILDING <br />Building j�echanical <br />ddition <br />HEATSOURCE <br />PERMITCPmbinati0njLKJSPlumbing(WORKltralionliElectric <br />TYPEDemolitionSign <br />TYPEew <br />Nepal <br />Gas <br />Srinklerr/Maim. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />� <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK &DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />HOOD <br />_ <br />LAUNDRY TRAY <br />_RANGE <br />WATER HEATER <br />_ <br />CLOTHES6VASHER <br />l.1ETALFIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />� <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERITIF} THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISION OF Lr,!Nc AND CRIDINACES 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 REGULATI; "CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY'f0 PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I —OMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />.r�./ <br />S' nature of OwnedCbntractorTu oozed Agent '�— <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />PERMIT <br />