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PERMIT APPLICATIO��I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITEe A7DDRESS /� /1 PARCEL TAX I.D.# PERMi7 a / <br /> O���� l�('QUlO �`ll/ MU4 0•�-O <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRE55 ZIP PHONE <br /> I�{e��ne �-h �P�er�a� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � SQ'�� <br /> CONTRACTOR � � .�(00.'�,^� ADDRESS ZIP CONTR.LICENSE M <br /> PHONE o�bJ � '"�� �i� ��'�I� IJ V OQ� � <br /> PROPOSED USE OF BUILDING n Building I� Mechanicai Q Addition HEAT SOURCE <br /> PERMIT �_� Combination H Plumbing WORK L, Alteration � ElecUic <br /> TYpE �( Demolition IJ Sign TYPE D New Gas <br /> L) Sprinkler U RepainMaint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%NRE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BAS�N) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTI�ES WASHER _ METAL FIREPLACE/STOVE I <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 /> � � � <br /> I I HEREBY CERITiFY THAT I HAVE READ AND E)CP.MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL �� <br /> I PROVISIONS OF L1WS AND ORIDINACES GOVERNING 7HIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING OF A PERI.�IT DOES NOT PRESUME TO GIVE AUTHORITY TO VICLATE OR CANCEL THE PROVISION OF ANY OTHER I <br /> iSTATE OR LOCAL LAW REGU WTING CONSTRUCTION OR THE PERFORAtANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE I <br /> , OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE i <br /> CONTRACTORS LAW 18.27 RGW AND 296.200 WAC. <br /> S���l �o�� ' <br /> Signature o(OwnenContractor/Aulhonzed Agent Date I <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br /> I _ J <br />