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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES 6- 63-11W <br />3200 CEDAR STREET, EVERETT, WA 98201 �%ot//4'cn3 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS ,i�/ <br />PARCEL TAX I.G. # <br />P R I if b� _ / <br />( r <br />1 <br />.,7/ 7 A 2 <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />Sr�G�o,C' <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE 95�� �7i��`�•Y F <br />�,I.�1o,7/ <br />PROPOSED USE OF BUILDING <br />PERMIT <br />R Coomtbilneation U Plumbing Me al <br />WORK <br />Ad"on <br />Alt1ratill <br />HEATS OURCE <br />Electric <br />TYPE <br />B Demolition U Sign <br />TYPE <br />ew <br />Gas <br />UUU Other <br />CONTRACT PRICE OF WORK <br />I CITY OF EVERETT L OCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />//sir FAtis � p,Py�.�r <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 />_ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />_ <br />FORCED AIR SYSTEMS G <br />HEAT PUMP <br />_ <br />_ <br />_ <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />_� <br />UNIT HEATERS �( <br />CLOTHES DRYER' <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRYTRAY <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 />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICEIBAR/MOPIETC.) <br />y� <br />EXHAUST FAN L' <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 AUTHORITI' 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 1 COMPLY WITH THE STATE <br />CONTRACTORS 16.27 RCWW AND 296.200 WAC. <br />SLAWW <br />SlgnaTre of Owners omwintorlAUmonzea agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />