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PERMIT APpLIG <br />ERMIT APPLICA ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -FAX 425-257-8857 <br />:�-� <br />SITE ADDRESS.., <br />PARC,,EL TAX I.D. # <br />PERMIT # <br />Frn u� LEf <br />VL�L <br />CJv r1�}//.� 7S Oc�/ <br />I ,% o <br />LEGAL LOT N0. <br />DESC. LCGJ1� <br />AA BLOCK <br />\'`{�Jt`��� L'v� <br />TRACT <br />5k\E <br />`p <br />OWNER ADDRESS ZIP PH,O' NE <br />��V` ►-�ti�n�n! Suc. cr�v��— ��t� fb"LGI /'{�zs-Lsz- <br />TENANT NAME <br />CONTACT FOR PERMIT HONE <br />CONTRACTOR ADDRESS ZIP CONTR. IFF NSE # <br />PHONE S <br />PROPOSED USE OF BUILDING <br />�bZS <br />Building li Mechanical <br />fi P.ddilion <br />r' <br />HEAT SOURCE <br />PERMIT <br />TYPE <br />Combination Plumbing <br />Demolition Sign <br />WORK Alteration <br />'rt PE New <br />Electric <br />�F� <br />Gas <br />Sprinkler <br />Repair/Maim. <br />Other <br />CONTRACT PRICE GF WORK '.� � .�, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />•«••••• NfW C43GF[£. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />FGRCED AIR SYSTEMS <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />_HEAT <br />PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />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 <br />INSERT <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />_ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERTIFY 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 />Signature of Owner/Contractor/Authorized Agent Date <br />L <br />\J <br />DEBIT &CREDIT CARDS .ARE NOT ACCEPTED <br />