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SITE DDRESS <br />i <br />LEGA LOT N0. <br />DES^. <br />OWNER <br />TENANTNAME <br />PE.�MIT APPLICATIG.J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-5857 <br />PARCEL TAX I.D. M <br />BLOCK I TRACT <br />ICONTACTNAME <br />CONTRACTOR /n/ AD�RESS <br />PHONE �/"`E.%l�/ ��e.GCC� <br />PROPOSED USE OF BUIL�ING I f"1 Building f"1 Mechanical <br />PEPMIT �_� Combination H Plum6ing <br />TYPE �j Demolition LI Sign <br />U Sprinkler <br />. l.C,.,r <br />PERMIT M <br />PHONE <br />LP CONTR. UCENSE N <br />RAddition I HEAT SOURCE <br />Alleration n Electric <br />BNew K Gas <br />Repair/Maint. I_J Other <br />CONTRACT PRICE OF WOflK CITY OF EVEREIT LOCAL SALcS TAX CO�E IS 3:05 <br />WORK OESCRIPTION <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPlETC.) <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />1 hIEREBY CERITIFY T4AT I HAVE READ AND EXAMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. 0.LL <br />PROVISIONS OF LqWS AND ORIDINACES GOVERNING THIS TYPE OF WORK W�LL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERb11T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THG PROVISION OF ANY OTHER <br />STATE OF LOCAI :AW �iEGULATING CONSTRUCTION OR THE PERFORMF.NCE OF CONSTRUCTIQN. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PFONERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COtdPLY WITH THE STATE <br />CONTRACTORS LAW 1i327 RCVV AND 296.200 WAC. <br />A� <br />Signawre of OwnedConlractodAWhorized Agenl Date <br />