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PE�2MIT APPLICATION <br /> CITY OF tVERETT PERMIT SERVICES <br /> 3200 CEDAR STRFET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> S�TE�ADDR���r� �S PARCEL TAX I.D.i� MP��# v � / „ <br /> CL" <br /> a' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS ZIP PHONE <br /> JC�111 `1��P11(� �6(1 ���� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> . -�a�11 �� <br /> CONTRACTOR �' M �Q�� (� AD�RESS ZIP CONTR.LICENSE t � <br /> -5 ��I i5 .t3ro�c�cx�Q�P <br /> PHONE �rq _ �/,. /_� � <br /> :J �,��� <br /> PROPOSED USE OF BUILDING I"") Building Mechanical Addition HEAT SOURCE <br /> PERMIT �_� Combinalion R�( Plumbing WORK Alteralion Q ElecVic <br /> TYPE �j Demolition �J Sign TYPE New �..j Gas <br /> U Sprinkler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA7C CODE IS�105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. 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 /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY _ 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/A10P/ETC.) __ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ ANG EXAMINED l HIS APPLICATION AND KNOW THE SFME TO BE TRUE AND CORRECT. AlL I <br /> PROViSIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOftK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING OF A PERMIT UOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> �' STATE OR LOCAL LAW REGUiATING CONSTRUCTIOR OR THE PERFORh7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 0Y THE , <br /> OWNER OF THIS PROPERTY TO PERFQRAI THE WORK FOR IVHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ICONTRACTORS LAW 18.27 RCW AND 296.200 WAC. � <br /> � ;g�a�� � <br /> i, ' <br /> SignaWre of OwnedConlractor/Authonzed Agent ' D�ate <br /> j DEBIT & CREDIT CARDS ARE NOT ACCCPTED <br />