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Pr9MIT APPLICATIC'I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRt_ET, EVERETT, WA 98201 <br />425-257-88' 0 - FAX 425-257-8857 <br />/ / <br />SITE ADDRESS <br />PARCEL TAX I.D. # PEttg�MIT x <br />l LL •!J �- LACE <br />/ir n / <br />J7� '�/"I^�/•Ci' <.�11b r25 <br />LEGAL LOT NO. <br />BLOCK <br />_ <br />TRACT ^ _� <br />/ <br />OWNER <br />ADDRESS ZIo PHONE <br />TENANT NAME <br />I CONTACT NAME PHONE <br />CONTRACTOR <br />6o)Er�T r:-v 1�� r <br />ADDRESS ZIP CONTR. LICENSE # <br />inc ;i��y - Sr 9eZS3 GC,-, -r#1 o_�'vC <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />f8ing n tdechanical <br />Combination FLr--J(( Plumbing <br />Demolition Sign <br />AddihDn <br />WORK Alteration <br />TYPE ¢�R�(-� <br />HEAT SOURCE <br />Electric <br />Ilj'��dS <br />Sprinkler <br />L/ RepainMaint. <br />LJ Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C - A HANDLING UNITS <br />BATHTUB <br />r— <br />FORCED AIR SYSTEMS <br />J[_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHCWER <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />ANGE HOOD <br />LAUNDRY TRAY <br />-WATER HEATER <br />c . <br />r <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEBAR/MOP;ETC.) <br />OTHER <br />,2 _ <br />�� <br />1_-EXHAUST <br />FIREPLACE INSERT <br />AS FIREPLACE <br />GAS RANGE <br />AS PIPING <br />FAN <br />OTHER <br />_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OP.IDINACES GOVERNING THIS TYPE CF 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 TH PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C,DNTRACTe9S LAW 18.27 RCW AND 296.200 WAC. <br />mzea .+gem uale <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />