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� 1� PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CFDAR STREET, EVERETT, WA 98201 <br /> 425-257-BB10- FAX 425-257-6657 i <br /> � --�f � <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT a <br /> s�,r'; , : ' �}o�� lo�, ot7 00 ° jo 7 - � <br /> LEGA LOT NO. BLOCK TRACT � <br /> DESC. � <br /> OWNER ADDRESS ZIP PHONE <br /> �j�� �.} �,��" ;. ; . � �v3 t (r2Ai�rJ �7'Y� �1 `/�5 Y!t SSo � <br /> TENANT NAME CONTACT NAME PHONE � <br /> � <br /> OI�N�.12 <br /> CONTRACTOR O��N��(' ADDRESS ZIP CONTR.UCENSEN i <br /> I <br /> PHONE <br /> i <br /> I <br /> PROPOSED USE OF BUILDING fl Building fl Mechanicai Addition HEAT SOURCE <br /> PERMIT t�f Combination �--� Plumbing WORK Alteration Elecuic <br /> TYPE �j Demolition LJ 5�9� TYPE New Gas i <br /> �1 U Sprinkler(#et heads) Repeir/Maint. Other �, <br /> /.1N�IC.-( I�tS. <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> WORK DESCRIPTION <br /> ADO�7�or•� oF �EAk�,t�MS ANh N.�oK <br /> �7(� s�. -�t �i <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> � WATER CLOSET(TOILET) A!C—FVHA�JDLING UNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> I LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER � UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIPY THAT I HAVE READ AND EXPMINED 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 C0�.IPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERh11T 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 PERFORAI THE WORK FOR WHICH i�PPLICATION IS MADE AND I COMPLY WITH THE STATE . <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> % f 6-3- o i <br /> /� <br /> �,-=,< <br /> Signature of Owr�er/Contractor/Authonzed Agent Date <br /> (`��jp7-DU `.� <br /> �_ - <br />