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PERMIT APPLICATION S�z <br />CITY OF EVERETT PERMIT SERVICES D5 <br />9071 61 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />gW425-257-8810 — FAX 425-257-8857 <br />a z-)S7r ct3 ci3 <br />, <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />ERMIT 4 <br />5t/-+ W PLA4C� <br />L�)C.13`1'32C%D/CZ- <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC.01 <br />( <br />T$E t�Lv`-T -iL <br />OWNER ADDRESS ZIP PHONE <br />-,j I rh (,YMQC-VQ 5bu3 4u=3ss2436 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />J I,m KA-a t2e'-O�J <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building fiJ Mechanical <br />Combination Plumbing <br />Addition <br />WORKIleration <br />HEAT SOURCE <br />D Electric <br />1 ' <br />TYPE <br />FhL=�J(, <br />Demolition Sign <br />TYPE ew <br />�U] Gas <br />I "VLT �r�0N11,� <br />/ r V <br />Sprinklef <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />WORK DESCRIPTION I Ly /1 _nr <br />( 60S-))t0 "-V?4 OF .�W �iu�Ti- `l vY 6/, <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 />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES 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 INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICErBAR/MOP,ETC.) <br />EXHAUST FAN <br />_ <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 neriUontraCtOr/Autherized Agent Date 1/2 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />