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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 />SITE ADDRESS / <br />PARCEL TAX I.D. # <br />PERMIT z <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWG/NE.R,� ADDRESS ZIP PHONE <br />C i/`LlG1Ll�C�� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE p <br />PHONE & ( / <br />PROPOSED USE OF BUILDING <br />I7 <br />PERMIT <br />Building f� Mechanical <br />Combination ILH�/ Plumoin9 <br />WORK <br />Addi!ion <br />Alteration <br />I HEAT SOURCE <br />Electric <br />Gas <br />'/ <br />�^� <br />IIFU�(; <br />TYPE <br />Demolition Sign <br />Sprnklef <br />TYPE <br />New <br />Repair/Mainl. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES T... X CODE IS 3105 <br />WORK DESCRIPTION <br />Spri��c �,,�� %� ZQKdS <br />/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A1C — 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 />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />_ <br />CLOTHES WASHER <br />_ <br />FIREPLACE INSERT <br />_ <br />URINAL <br />DRINKING FOUNTAIN <br />_ <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 />_ <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 />THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />REGULATINGSTATE OR LOCAL LAW OR THE PERFORMANCE OFCONSTRUCTION. AUTHORIZED 8Y THE <br />STATE <br />OWNER OF TTHIS PROPERTY TOPERFORM THE WORKFOR WHICH APPLIC TON IS MADE AND ICOMP Y W TH THE S <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />Signature of OWnerIContractor/Authorized Agent Date <br />/�� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />