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P�RMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> ��ADDIRESS�[���� ��� PARCEL TAl(I.D.# f�/QERA9 b� �� <br /> ,� <br /> �, \ <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRE55 ZIP PHONE <br /> �a���e�a.. ����c� �,.5� - 5� 5 �7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 5 a(Y1� <br /> CONTRACT���_�� � �QQ—h n,�, ADDRES j� I � �rO�� �� ZIP CONTR.UCENSE M <br /> 1 c_{ <br /> J <br /> PHONE [ <br /> PROPOSED USE OF BUILDING Building n Mechanical Addition HEAT SOURCE <br /> PERMIT Combination H Plumbiny WORK Alteretlon nu Electric <br /> TYPE Demolition �� Sign IYPE � New �j Gas <br /> 8prinkler RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK '/��J CI1Y OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOW ER 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 N FIREPLACE WSERT <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 — — — I <br /> I I HEREBY CERITIFY THAT I HAVE READ AND EXAAIINED THIS APPLICATIOtJ AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL i <br /> PROVISIONS OF L4WS AND ORIDINACES GOV�RNING THIS TYPE OF N'ORK WILL BE COMFLIED WITH 6NHETHER SPECIFIEO HEREIN OR <br /> iNOT. THE GRANTING OF A PERMIT DOES NOT PRESUhtE TO GIVE AUTHORITY TO VIOL�I7E OR CANCEL THE PROVISIGN OF ANY OTMER � <br /> STATE OR LOCAI L1W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSlRUC710N. THAT I AM AUTMORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE N'ORK FOR WHICH APPLICATION IS MADE AN�I COMPLY WITH THE STATE � <br /> I CONTRACTORS LAW 18.27 RCW AND 296'200 WAC. ' <br /> I ������ L� �� I <br /> Signature of OwnenContractor/Authorized Agent Date I, <br /> I DEBIT 8 CREUIT CARDS ARE NOT ACCEPTED � <br />